presented  to  the 

LIBRARY 

UNIVERSITY  OF  CALIFORNIA  •  SAN  DIEGO 

by 

FRIENDS  OF  THE  LIBRARY 

MRS.    JOHN  ALLEN   COLE 


^mJdi 


LIBRARY     ; 

UNIVERSITY  <^P         5 

SAN  x>itm     J 


FirstAM 
to  thelnjured 


Plain  and  simple  rules  to  be  followed  in 

cases  of  accident  or  emergency 

as  well  as  in  the  first 

stages  of  illness 


PKi  1  cvd  e/l  p  K  i  dk. 
^<^Pcni\  PublUKiivg    CoiT\pc\i\y 
.     ^_^___^  1907 


Copyright  1903  by  The  Penn  Publishing  Company 


Rrst  Aid  to  the  Injured. 


Table  of  Contents 


PAGE 

Introduction 5 

CHAPTER  I 

THE  CONSTRUCTION   OF  THE   HUMAN   BODY 

Its  Cells,  Tissues,  and  Organs 7 

CHAPTER  II 

THE   APPLICATION   OF   BANDAGES 

The  Kinds  of  Bandages,  their  special  uses,  and  the  way  to 

apply  them 11 

CHAPTER  III 

HAEMORRHAGE  AND   ITS   IMMEDIATE  TREATiMENT 

Bleeding,  external  and  internal,  its  Varieties,  Symptoms, 

and  Treatment  ))y  pressure,  by  Tourniquets,  etc.  ...      75 

CHAPTER  IV 

WOUNDS  AND   THEIR   IMMEDIATE  TREATiMENT 

Simple  and  poisoned  Wounds  ;  Stings  of  Insects  ;  Snake 

and  Dog  Bites,  and  what  to  do  for  them 108 

CHAPTER  V 

SPRAINS,    DISLOCATIONS,    FRACTURES,  ETC. 

The  Causes.  Signs,  and  Treatment  of  such  Injuries  ;  how  to 
apply  Splints  ;  the  Transportation  of  persons  suffering 

witl-  broken  bones,  etc 117 

3 


4  TABLi:  OF  CONTENTS 

CHAPTER  Vr 

ARTIFICIAL   RESPIRATION   AND  THE  TREATMENT  OF 
ASPHYXIA 

The  various  ways  of  promoting  Artificial  Breathing  ;  the 
Treatment  of  persons  Apparently  Drowned  ;  and  of 
those  suffering  from  Strangulation  and  Choking  ...    157 

CHAPTER  VII 

POISONS   AND   THEIR   IMMEDIATE  TREATMENT 

How  to  tell  whether  Poison  has  been  taken,  and  of  what 
sort ;  what  to  do  in  general  if  poison  is  suspected  ; 
special  Poisons  and  their  treatment 172 

CHAPTER  VIII 

INSENSIBILITY    AND   FITS 

The  causes  and  symptoms  of  Shock  ;  Brain  injuries,  Apo- 
plexy, Intoxication,  Epileptic  and  other  Fits,  Hys- 
teria, and  Convulsions  of  Infants 192 

CHAPTER  IX 

BURNS   AND  SCALDS 

How  to  treat  them  ;  Shocks  by  Electricity  ;  Removal  of  ob- 
jects from  the  Eye,  Ear,  and  Nose 207 

CHAPTER  X 

PREPARATION   FOR  A   CASE  OF  ACCIDENT  OR 
SUDDEN   ILLNESS 

Preparation  of  Room,  Bedstead,  and  Bed  ;  Specia.  Bed  for 
Fractures  ;  carrying  the  patient  up-stairs  ;  lift:ng  into 
bed,  etc 215 


INTRODUCTION 

The  scope  of  First  Aid  is  not  to  supersede 
medical  or  surgical  treatment,  but  to  render  im- 
mediate temporary  assistance  to  a  person  suffer- 
ing from  an  accident  or  sudden  illness  until  the 
arrival  of  a  doctor. 

The  importance  of  First  Aid  will  be  apparent 
in  such  cases  as — Haemorrhage  from  a  wounded 
artery,  Drowning,  or  a  severe  case  of  Fracture; 
in  any  one  of  the  above  it  might  make  all  the 
difference  in  saving  the  life  or  limb  of  a  patient 
as  to  whether  immediate  treatment  was  rendered 
efficiently  or  improperly. 

First  Aid  should  teach  us  how  to  render 
temporary  assistance  by  improvised  means  for 
the  relief  of  the  patient,  and  the  methods  by 
which  he  can  be  removed  to  a  place  of  safety. 
With  these  objects  in  view,  the  following  pages 
contain,  the  Application  of  Bandages,  the  Tri- 
angular Bandage  being  described  first,  as  this 
is  most  suitable  for  extemporized  dressings  ;  then 

5 


6  INTRODUCTION 

comes  the  chapter  on  the  Immediate  Treatment 
of  Haemorrhage, — from  a  First  Aid  point  of  view 
this  is  a  subject  of  the  greatest  importance ;  if 
proper  help  is  not  at  hand  a  patient  with  a 
wounded  artery  might  bleed  to  death  in  a  few 
minutes.  Then  follow  the  chapters  on  the  Im- 
mediate Treatment  of  Wounds,  Dislocations  and 
Fractures ;  Asphyxia,  Poisoning,  Insensibility, 
Burns  and  Scalds,  etc. ;  and  finall3%  Preparation 
for  the  Keception  of  a  case  of  Accident  or  Sud- 
den Illness. 


FIRST   AID 

To  The  Injured  and  Sick 


CHAPTER  I 

THE   CONSTRUCTION    OF   THE   HUMAN   BODY 

The  Cell — Its  Structure  and  Properties — The  Tissues — Kinds 
of  and  how  formed — The  Organs — How  formed — Their 
different  groups. 

The  human  body,  like  that  of  all  animals,  is 
built  up  of  cells,  which  may  be  regarded  as  the 
primary  or  fundamental  units  of  its  construc- 
tion. 

The  Structure  and  Properties  of  a  Cell. — A  cell 
is  of  microscopic  dimensions,  and  in  its  simplest 
form,  e.  g.,  a  white  blood  corpuscle,  is  seen  to 
consist  of  two  distinct  parts,  viz.  : — 

(I)  The  Main  Substance  of  the  Cell. — This  is 
7 


8  FIRST  AID    TO   THE  INJURED 

termed  proto2)lmm^  and  is  a  clear  jelly-like 
mass ;  - 

(II)  The  Kernel  of  the  Cell. — This  is  termed 
tiie  nucleus.  It  is  generally  placed  near  the 
centre  of  the  cell  and  is  denser  in  structure  than 
the  main  substance.  Some  cells  contain  more 
than  one  nucleus. 

Cells  vary  in  shape  and  size,  the  shape  depend- 
ing upon  the  position  and  the  functions  they 
have  to  perform.  Thus,  cells  may  be  round, 
long,  oval,  stellate,  ciliated  (furnished  with  hairs) 
or  flaky. 

A  cell  possesses  the  power  of  reproducing 
itself  by  division,  of  moving  about,  of  taking  in 
nourishment  and  digesting  it,  and  of  excreting 
waste  material.  Every  cell  is  therefore  j)racti- 
cally  a  living  organism. 

The  Elementary  or  Simple  Tissues  of  the  body 
are  formed  by  the  aggregation  of  similar  cells. 

They  comprise  the  following  : — 

1.  Epidermal  or  Epithelial  Tissue  (epidermis 
and  the  cellular  lining  of  mucous  membranes). 

2.  Connective  Tissue  (fat  and  tendon). 

3.  Cartilaginous  Tissue  (gristle). 

4.  Osseous  Tissue  (bone). 
6.     Muscular  Tissue. 


m^ 


THE  CONSrnUCTION  OF  THE  HU3IAN  BODY        9 

6.  Nervotis  Tissue. 

7.  Blood. 

AVben  several  of  the  elementar}^  tissues  are 
combined  together  they  form 

The  Compound  Tissues,  these  comprise  the  fol- 
lowing : — 

1.  The  Blood  Vessels  (which  consist  of  con- 
nective, muscular  and  nervous  tissue). 

2.  The  Lymphatics  (which  consist  of  connec- 
tive and  muscular  tissue). 

3.  The  Shin  (which  consists  of  connective, 
muscular,  nervous  and  epidermal  tissue). 

4.  The  Seroios,  Synovial  and  Mucous  Mein- 
hranes  (which  consist  of  connective,  epithelial, 
nervous,  and  muscular  tissue). 

When  several  tissues  combine  together  to 
form  a  special  structure,  having  peculiar  and 
definite  functions,  there  is  produced  what  is 
termed  an  organ. 

The  Organs  of  the  Body  may  be  arranged  into 
groups  or  systems  according  to  their  special 
functions,  thus : — 

1.  The  Organs  of  Locomotion ^\hQ'&^  comprise 
the  bones  and  muscles. 

2.  The  Organs  of  Circulation^  these  comprise 
the  heart  and  blood  vessels. 


10  FJEST  AID   TO   THE  INJURED 

3.  The  Orga7is  of  J^espiration,  these  comprise 
the  lungs  and  air  passages. 

4.  The  Orga7is  of  Digestion^  these  comprise 
the  mouth,  gullet,  stomach,  and  intestines. 

5.  The  Organs  of  Secretion^  these  comprise 
the  liver,  pancreas  (sweet  bread),  salivary  glands, 
and  mucous  glands. 

6.  The  Organs  of  Excretion^  these  comprise 
the  skin  and  kidneys. 

7.  The  Nervous  Organs,  these  comprise  the 
brain,  spinal  cord  and  nerves  (including  the 
organs  of  special  sense,  i.  e.,  sight,  hearing, 
smell,  taste,  and  touch). 

8.  The  Organs  of  Reproduction. 


CHAPTER  II 

THE   APPLICATION    OF   BANDAGES 

Uses  of  Bandages— Kinds  of  Bandages— The  Triangular  Band- 
age ;  how  to  make  it,  how  to  fold  it  for  storage,  its  advan- 
tages, w^ays  in  which  it  may  be  used,  manner  of  folding  it 
broad  or  narrow,  the  "  reef  "  and  "granny  "knots,  methods 
of  applying  the  narrow,  broad,  and  large  arm  slings — The 
Triangular  Bandage  for  wounds  of  the  scalp,  forehead, 
back  of  head,  temple,  chin,  ears,  side  of  face,  eye,  neck, 
shoulder,  chest,  back,  ribs  (also  for  fracture  of),  abdomen, 
upper  arm,  elbow,  forearm,  wrist,  hand,  hip,  thigh,  knee, 
leg,  foot,  lower  part  of  abdomen  or  perinaeum,  groin — The 
Triangular  Bandage  for  the  stump  of  a  limb,  for  fracture  of 
the  lower  jaw,  for  securing  splints,  for  arresting  hsemor- 
rhage— The  Roller  Bandage  ;  its  divisions,  its  sizes,  how  to 
roll  it,  its  named  parts,  points  to  be  remembered  in  its  ap- 
plication, the  manner  in  which  it  may  be  applied — The 
Circular  Bandage— The  Spiral  Bandage— The  Reverse  Spiral 
Bandage— The  Oblique  Bandage— The  Figure  of  8  Bandage 
— The  Spica  Bandage — The  Spica  for  the  groin,  the  shoulder, 
the  female  breast,  the  thumb,  the  great  toe,  the  heel,  the 
elbow,  the  knee — To  apply  the  roller  bandage  to  the  upper 
extremity,  to  the  finger,  to  the  lower  extremity — The 
Head  Bandages,  viz.,  capeline  and  twisted  -Bandage  for  the 
chest  and  the  abdomen — Bandages  of  special  form,  viz. — 
11 


12  FIRST  AID   TO    THE  INJURED 

The  Square  Baudage — The  Four-tailed  Baudage  for  the 
jaw,  head,  aud  knee— The  Mauy-tailed  Baudage  aud  the  T 
Baudage. 

Bandages  are  employed  for  the  following  pur- 
poses : — 

(I)     To  give  support  to  injured  parts. 
(II)     To  keep  dressings  in  place. 

(III)  To  fix  splints  and  other  apparatus. 

(IV)  To  overcome  excessive  muscular  action. 
(V)     To  stop  bleeding  hy  means  of  pressure. 

(YI)     To  protect  wounded  parts  from  exposure. 

The  kinds  of  bandages  in  general  use  are : — 
(I)     The  Triangular  Bandage. 

(II)     The  Koller  Bandage. 
(Ill)     Bandages  of  special  form. 

I.     THE  TRIANGULAR  BANDAGE  AND  ITS 
APPLICATION 

To  make  the  Triangular  Bandage. — Take  a 
piece  of  linen  or  unbleached  calico  not  less  than 
thirty-eight  inches  square,  fold  it  diagonall}^  and 
cut  it  along  the  fold.  Each  of  the  triangular 
pieces  will  then  form  one  bandage.  The  named 
parts  of  the  Triangular  bandage  are :  The  base 
of  the  triangle — this  is  termed  the  Lower  Bor- 
der;   the   two   sides   of   the   triangle — the   Side 


THE  APPLICATION  OF  BANDAGES  13 

Borders;  the  apex  of  the  triangle — the  Point; 
the  remaining  corners  of  the  triangle^the  two 
ends.     (Fig.  1.) 

POINT 


of 


€^ 


^^ 


END/l-§ LN,END 

LOWER     BORDER 

Fig.  1.— Triangular  Bandage. 


To  fold  the  Bandage  for  Storage. — First,  spread 
the  bandage  out  flat,  then  fold  it  perpendicularly 
down  the  centre,  placing  the  right  end  on  the 
left.  Now  bring  the  ends  thus  folded  and  the 
point  to  the  centre  of  the  lower  border,  forming 
a  square  ;  then  fold  the  square  in  half  from  right 
to  left,  next  fold  the  two  ends  over  or  vice  versa, 
making  them  meet  in  the  centre  ;  now  double 
again  in  half  (this  will  give  a  packet  7^^xS}i") 
,and  secure  with  a  pin.  If  folded  over  once  more 
it  forms  a  neat  pad.     (Fig.  2.) 


14 


FIRST  AID   TO   THE  INJURED 


:^c 


BC  BC 

Fig.  2.— Method  of  folding  triangular  bandage  for  storage. 

The  Triangular  Bandage  has  the  following  ad- 
vantages : — It  can  be  easily  made  from  a  hand- 
kerchief, and  is  therefore  well  suited  as  an  emer- 
gency bandage ;  its  application  can  be  easily 
acquired ;  temporary  dressings  may  be  fixed 
better  with  it  than  with  the  Roller  bandage,  and 
it  can  be  used  for  almost  every  purpose  for  which 
a  bandage  is  required. 


THE  APPLICATION  OF  BANDAGES 


15 


The  Triangular  Bandage  may  be  applied  : 
(I)     Unfolded  (called  a  ''  whole  cloth  "). 
(II)     Folded  broad. 
(Ill)     Folded  narrow. 

To    Fold    the  Bandage   Broad   or  Narrow. — 
Spread  the  bandage   out   and   carry  the  point 


8 


\ 


/\..^...  L.7\. 


.-s 


JL. 


2:n. 


Fig.  3— Method  of  folding  triangular  bandage  broad  and  narrow, 
lor  use. 


IG  FIRST  AID    TO   THE  INJURED 

(luvvii  to  the  lower  border.  If  required  broad, 
fold  it  length  ways  upon  itself  once.  If  required 
narrow,  fold  it  lengthways  upon,  itself  twice. 
(Fig.  3.) 

To  fasten  the  Bandage  after  applying  it,  either 
pin  it  with  a  safety  pin  or  tie  a  reef  or  sailor's 
knot ;  never  tie  a  "  granny  "  knot. 

To  tie  the  Reef  Knot  proceed  as  follows :  hold 
the  ends  of  the  bandage  in  the  two  hands ;  wind 
the  end  held  in  the  right  hand  over  that  held  in 
the  left ;  then  wind  the  end  now  held  in  the  left 
over  that  held  in  the  right,  and  bring  it  through 
the  loop. 

The  reef  knot,  if  properly  tied,  should  have  its 
free  ends  l3'ing  in  the  same  line  as  the  bandage. 
In  the  "  granny  "  knot  the  ends  lie  at  right  angles 
to  the  bandage.  The  advantages  of  the  reef 
knot  over  the  "  granny  "  are,  that  it  is  firmer,  is 
less  liable  to  slip,  and  it  is  easily  untied. 

The  use  of  the  Triangular  Bandac4e  as  a 
Sling  For  the  Forearm 

The  following  slings  may  be  applied  with  the 
Triangular  bandage  : — 

I.  The  Narrow  Arm  Sling. — This  is  applied  by 
first  folding  the  bandage  narrow,  then   placing 


THE  APPLICATION  OF  BANDAGES  17 

one  end  over  the  shoulder  of  the  uninjured  side, 
and  allowing  the  other  end  to  hang  down  in 
front ;  the  forearm  is  now  bent  to  the  required 
height,  the  hanging  end  is  drawn  up  in  front  of 
it  and  over  the  shoulder  of  the  injured  side  and 
the  two  ends  are  then  tied  behind  the  neck. 

2.  The  Broad  Arm  Sling. — This  is  made  by 
folding  the  bandage  broad,  i.  e.,  once  on  itself, 
and  is  applied  in  precisely  the  same  way  as  the 
narrow  arm  sling. 

3.  The  Large  Arm  Sling  is  applied  in  two 
ways : — 

(I)  As  a  Support  for  the  Forearm^  thus : — 
Place  the  apex  of  the  bandage  below  and  well 
beyond  the  elbow  of  the  forearm  on  the  injured 
side,  and  the  upper  end  across  the  top  of  the  op 
posite  shoulder  (Fig.  4) ;  then  carry  the  forearm 
across  the  chest  to  the  desired  level,  now  bring 
the  lower  end  upward  across  the  forearm,  pass 
it  over  the  shoulder  of  the  injured  side,  and  tie 
the  two  ends  behind  the  neck ;  then  draw  the 
apex  forward  over  the  point  of  the  elbow  and 
pin  it  to  the  bandage  in  front.     (Fig.  ^a.) 

(II)  As  a  Support  for  the  Elbow,  thus : — Place 
the  bandage  with  one  end  on  the  shoulder  of  the 
injured  side  and  the  apex  pointing  in  the  oppo- 


18 


FIRST  AID    TO    THE  INJURED 


S> 


Fig.  4.  Fig.  ia. 

Figs.  4.  4a.— The  Large  Arm  Sling  applied  as  a  support  lor  the 
Forearm. 

site  direction  to  the  elbow  ;  then  flex  the  fore- 
arm on  the  injured  side,  and  place  it  across  the 
front  of  the  chest  with  the  fingers  touching  the 
opposite  shoulder  (Fig.  5);  now  draw  the  lower 


THE  APPLICATION  OF  BANDAGES 


19 


i:d  over  the  elbow  and  across  the  front  of  the 
Iicst  to  the  top  of  the  shoulder  on  the  uninjured 


side,  and  tie  it  to  the  upper  end  (Fig.  5«) ;  then 
take  the  apex,  fold  it  well  over  the  forearm  and 


20 


FIBST  AID   TO   THE  INJURED 


pin  it  to  the  bandage  above  on  the  injured  side. 
(Fig.  6h.) 


A*- 


Fig.  5b. 
The  Large  Arm  Sling  applied  as  a  support  for  the  Elbow. 

The  Triangular  Bandage  for  Wounds 
Here  before  applying  the  triangular  bandage, 
it  is  important  in  all  cases  to  first  apply  to  the 
wound  clean  (antiseptic)  dressing,  in  the  form  of 
a  pad. 

I.    For  a  wound  of  the  Scalp,  first  fold  the 


THE  APPLICATION  OF  BANDAGES 


21 


lower    border    of    the   bandage   lengthways   to 
form  a  hem  1^  inches  wide,  then  place  it  with 

A 


Fig.  6.  Fig.  6a. 

Fig.  6,  6a.— The  triangular  bandage  for  the  Head. 

the  middle  of  the  hem  over  the  centre  of  the 
forehead  just  above  the  root  of  the  nose,  and  the 
point  hanging  over  the  back  of  the  head  to  the 
neck ;  now  carry  the  two  ends  backward  above 
the  ears  (which  are  left  out),  cross  the  ends  be- 
hind at  the  nape  of  the  neck  over  the  point  and 
below  the  occiput  (the  prominence  at  the  back  of 
the  head) ;  this  is  important,  otherwise  the  band- 
age will  not  remain  tight,  bring  the  ends  forward 
and  tie  them  in  front  on  the  forehead  (Fig.  6). 


22  FIRST  AID    TO    THE  INJURED 

Next  pull  the  point  down,  to  make  the  bandage 
tit  well  over  the  head,  then  turn  it  over  on  to  the 
top  of  the  head  and  pin  it.     (Fig.  Qa.) 

2.  For  wounds  of  the  Forehead  or  Back  of  the 
Head,  fold  the  bandage  narrow,  place  the  centre 
of  it  over  the  pad  on  the  wound,  carry  the  ends 
horizontally  round  the  head,  cross  them,  and 
knot  off  over  the  dressing. 

3.  For  a  wound  of  the  Temple,  place  the  centre 
of  the  bandage  folded  narrow  on  the  opposite 
temple  to  the  one  wounded,  bring  the  ends  for- 
ward, cross  them  over  the  pad  placed  on  the 
wound  (Fig.  Y),  then  carry  them  respectively 
over  the  top  of  the  head  and  below  the  jaw,  and 
tie  on  the  sound  temple  exactly  opposite  the 
crossed  ends.     (Fig.  7^.) 

4.  For  wounds  of  the  Chin,  Ears,  or  Side  of 
the  Face,  place  the  centre  of  the  bandage  folded 
narrow  under  the  chin,  carry  the  ends  upward 
and  tie  on  the  top  of  the  head. 

5.  For  wounds  of  both  Eyes,  place  the  centre 
of  the  bandage  folded  narrow  on  the  bridge  of 
the  nose,  carry  the  ends  backw^ard,  cross  them, 
bring  them  forward  and  tie  in  front. 

6.  For  a  wound  of  one  Eye,  place  the  centre 
of  the  bandage  folded  narrow  over  the  injured 


THE  APPLICATTON  OF  BANDAGES 


23 


eye,    pass  the  ends  obliquely,  one  upward  over 
the  forehead  and  the  other  downward  over  the 


J^9-  7.  ITig.  7a. 

Figs.  7,  7a.— The  triangular  bandage  for  the  Temple. 


Fig.  8.— The  triangular  bandage  for  the  Eye. 

ear,  cross  them  behind,  and  below  the  occiput. 


24  FIBST  AID   TO   IHE  INJURED 

then  bring  them  forward  and  tie  over  the  pad  on 
the  wound.     (Fig.  8.) 

7.  For  a  wound  of  the  Neck,  place  the  centre 
of  the  bandage  folded  broad  or  narrow  (accord- 
ing to  the  size  of  the  wound),  on  the  pad,  carry 
the  ends  round  the  neck,  cross  them,  bring  them 
back  and  tie  over  the  pad. 

8.  For  a  wound  of  the  Shoulder,  place  the 
centre  of  the  bandage  un- 
folded on  the  point  of  the 
shoulder,  with  the  point  of 
the  bandage  well  up  to  the 
angle  of  the  jaw,  and  the 
lower  border  across  the 
middle  of  the  upper  arm, 
then  carry  the  ends  round 
the  arm,  cross  them  on  the 
inner  side,  bring  them  for- 
ward and  tie  on  the  outside; 
now  place  the  forearm  on 
the  injured  side  in  a  narrow 
arm  sling,  then  pass  the 
point  of  the  bandage  under 

Fig.  9.-The  triangular  bandage^he  sling,  doublc  it  back  OU 
-     for  the  Shoulder.  -^g^^^^    ^^^    p-^^    |^    ^^    ^^IQ 

bandage  on  the  top  of  the  shoulder.     (Fig.  9.) 


THE  APPLICATION  OF  BANDAGES  25 

N'ote. — Should  the  shoulder  be  injured  so  as  not 
to  be  able  to  bear  the  weight  of  the  forearm  in  a 
sling,  after  applying  the  first  bandage  to  the 
wound,  take  a  second  bandage  folded  narrow, 
place  the  centre  of  it  over  the  point  of  the 
first  bandage,  carry  the  ends  obliquely  down- 
ward and  tie  them  under  the  armpit  on  the 
sound  side,  then  double  the  point  back  on  itself 
and  pin  it  to  the  bandage  on  the  top  of  the 
shoulder. 

9.  For  wounds  of  the  Front  of  Chest,  apply 
the  bandage  unfolded,  with  its  centre  across  the 
front  of  the  chest  and  its  point  over  the  shoulder 
on  the  injured  side  (Fig.  10) ;  carry  the  two 
ends  round  the  chest  and  tie  them  at  the  back, 
leaving  one  end  longer  than  the  other;  now 
draw  the  point  well  over  the  shoulder  and  tie  it 
to  the  longer  end  behind.     (Fig.  10a.) 

10.  For  wounds  of  the  Back,  apply  the  band- 
age in  a  reverse  way  to  the  above. 

11.  For  a  wound  of  the  Side  of  the  Chest,  take 
a  bandage  folded  broad,  apply  the  centre  of  it 
over  the  pad  on  the  wound,  carry  the  ends  round 
the  chest  and  tie  on  the  opposite  side.  Wote. — 
In  applying  this  bandage  it  should  be  tied 
just  tight  enough  to  retain  the  pad  in  position, 


26 


FIRST  AID    TO    THE  INJURED 


but  it  should  not  compress  the  chest   wall  un- 
duly. 


Fig.  10.  Fig.  10a. 

Figs.  10,  10a.— The  triangular  bandage  for  the  Chest. 


12.  For  a  wound  of  the  Abdomen,  apply  the 
centre  of  the  bandage  folded  broad  over  the  pad 
on  the  wound,  and  tie  the  ends  at  the  side. 

13.  For  a  wound  of  the  Upper  Arm,  apply  the 
middle  of  the  bandage  folded  narrow  over  the 
pad   on    the    wound,    carry  the  ends  backward, 


THE  APPLICATION  OF  BANDAGES  27 

cross  them  behind,  bring  them  forward  and  tie 
in  front;  then  place  the  forearm  on  the  injured 
side  in  a  narrow  arm  sling. 

14.  For  a  wound  of  the  Elbow,  a  bandage  may 
be  applied  in  two  ways:  — 

(J)  Flex  the  elbow  ;  then,  after  turning  in  a 
broad  hem  on  the  lower  border  of  the  bandage, 
place  tlie  centre  of  it  over  the  point  of  the  elbow 
with  the  point  of  the  bandage  upward,  pass  the 
ends  round  the  forearm,  cross  them  in  front, 
carry  them  round  the  arm  again,  cross  them  be- 
hind above  the  joint,  bring  them  forward  and  tie 
in  front  (Fig.  11) ;  then  draw  the  point  well  down 
and  pin  it  to  the  bandage  below  (Fig.  11a).  Now 
place  the  arm  in  a  narrow  arm  sling. 

(II)  Flex  the  elbow,  then  place  the  centre  of 
the  bandage  folded  broad  over  the  point  of  the 
elbow,  bring  the  ends  forward,  cross  them  in 
front,  carry  them  backwards  round  the  upper 
part  of  the  forearm,  cross  them  behind  and  below 
the  point  of  the  elbow  securing  the  lower  q(\^q 
of  the  broad  bandage,  then  bring  them  forward, 
again  cross  them  in  front,  now  carry  them  back- 
ward round  the  lower  part  of  the  upper  arm, 
securing  the  upper  edge  of  the  broad  bandage, 
and  tie  behind  just  above  the  point  of  the  elbow 


28 


FIRST  AID   TO   THE  INJURED 


(Fig.  lih).     Then  place  the  forearm  in  a  narrow 
arm  sling. 

15.     For  wounds   of  the   Forearm,  or  of  the 
Wrist,  apply  the  bandage  folded  narrow  in  the 


Fig.  11.  Fig.  11a.  Fig.  \\b. 

Figs.  11, 11a,  11&.— The  triangular  bandage  for  the  Elbow. 

same  manner  as  for  the  upper  arm,  and  then 
place  the  forearm  in  a  large  arm  sling. 

16.     For  a  wound  of  the  Hand. 

(I)  To  cover  the  Whole  Hand. — Spread  out  a 
bandage  unfolded,  place  the  hand  upon  it  with 


THE  APPLICATION  OF  BANDAGES 


29 


the  wrist  on  the  centre  of  the  lower  border — 
palm  downward  and  the  fingers  toward  the 
point  (Fig.  12) — turn  the  point  over  the  fingers 


Fig.  12a. 


30 


FIliST  AID    TO    THE  INJURED 


and  carry  it  across  to  the  back  of  the  wrist,  then 
draw  the  bandage  downward  on  each  side  of 
the  hand  (Fig.  l'2a\  and  pass  the  ends  upward 


Fig.  12&.  Fig.  12c. 

Figs.  12, 12a,  126, 12c.— The  triangular  bandage  for  the  Whole  Hand. 


round  the  back  of  the  wrist,  cross  thein  over  the 
point  (Fig.  l^h) ;  then  carry  them  in  front  of  the 
wrist,  bring  them  back  again  and  tie  them  over 
the  point  (Fig.  126^) ;  now  draw  the  point  over 
the  knot  and  pin  it  to  the  bandage  below. 

(II)  To  cover  the  Pahn  or  the  Back  of  the 
Hand. 

For  the  Pahn. — Place  the  centre  of  the  band- 
age folded  narrow  over  the  pad  on  the  wound, 
bring  the  ends  round  the  hand,  cross  them  on  the 
back  obliquely  ;  then  bring  them  over  the  wrist 


THE  APPLICATION  OF  BANDAGES 


31 


forward,  cross  them  in  front,  carry  them  bad 
.igain  over  the  wrist,  and  tie.     (Fig.  13.) 


Pig  13.— The  triangular  bandage 
for  the  Paliu  of  the  Hand 


Fig.  U.— The  triangular  bandage 
for  the  Fist 


I^or  the  Back. — Reverse  the  process. 

(Ill)  I^or  a  wound  iti  the  Palm  of  the  Hand, 
either  of  the  following  methods  may  be  used  : — 

{a)  Place  a  firm  pad  in  the  palm  to  well  fill 
it,  and  bend  the  fingers  over  the  pad,  now  apply 
the  centre  of  the  bandao:e  folded  broad  lontrjtu- 
dinally  across  the  bent  fingers,  carry  the  ends  up 
toward  the  wrist,  cross  them  just  below  the  root 
of  the  thumb,  then  take  them  round  the  wrist 
and  cross  them  on  the  opposite  side,  bring  the 


32  FIRST  AID   TO   THE  INJURED 

lower  end  forward  and  carry  it  over  the  first 
knuckle  of  the  index  finger  to  the  back  of  the 
wrist,  now  carry  the  upper  end  from  within  out- 
ward once  or  twice  round  the  wrist  and  then 
tie  the  two  ends  together.     (Fig.  14.) 

(b)  Squire's  Method. — After  placing  a  firm 
pad  in  the  palm  of  the  hand  and  bending  the 
fingers  over  it,  apply  the  centre  of  the  bandage 
folded  broad  across  the  back  of  the  wrist ;  now 
carry  the  thumb  end  of  the  bandage  diagonally 
across  the  front  of  the  hand  over  the  knuckles, 
and  across  the  back  of  the  hand  to  the  thumb 
side  of  the  wrist  again  ;  then  carry  the  other  end 
diagonally  across  in  the  opposite  direction ;  now 
bring  both  ends  round  to  the  front  of  the  wrist, 
cross  them,  pull  tight,  carry  them  round  to  the 
back  of  the  wrist,  and  tie. 

{c)  Spread  out  a  bandage  unfolded,  turn  up  a 
fairly  broad  hem  on  the  lower  border,  then  place 
the  closed  fist  with  a  firm  pad  in  it  on  the  cen- 
tre of  the  bandage — back  of  the  hand  down- 
ward— bring  the  point  over  the  fist  to  halfway 
up  the  forearm,  carry  the  ends  forward,  cross 
them  in  front  on  the  wrist,  then  carry  them 
backward  and  cross  them  on  the  back  of  the 
wrist,  again  bring  them  forward  and  tie  in  front. 


THE  APPLICATION  OF  BANDAGES  o*, 

now  draw  the  point  firmly  down  over  the  knot 
and  pin  it  to  the  bandage  below. 

After  the  hand  has  been  bandaged  by  any  of 
the  above  methods,  the  elbow  should  be  sup- 
ported in  the  large  arm  sling. 

17.  For  a  wound  of  the  Hip,  first  tie  one  band- 
age folded  narrow,  like  a  waist  belt,  round  the 


Fig.  15.— The  tiiangular  bandage  for  the  Hip. 


34  FIRST  AID   TO   THE  INJURED 

body  just  above  the  hips ;  then  apply  the  centre 
of  a  second  bandage  unfolded  on  the  wounded 
hip,  with  the  lower  border  well  down  on  the 
thigh,  carry  the  ends  backward  round  the  thigh, 
cross  them  behind,  bring  them  forward,  and  tie 
them  on  the  outside ;  now  pass  the  point  under 
the  narrow  bandage,  bring  it  down  and  pin  it  to 
the  bandage  below.     (Fig.  15.) 


\^^ 


V 


y/ 


Fig.  16— The  triangular  bandage  for  the  Foot. 


TBE  APPLICATION  OF  BANDAGES  35 

8.  For  a  wound  of  the  Thigh,  Knee,  or  Leg, 
apply  the  bandage  folded  broad,  in  the  same 
manner  as  for  the  upper  arm.  In  applying  the 
bandage  to  the  knee,  the  leg  should  be  kept 
straight  and  the  knot  should  be  tied  below  the 
knee-cap. 

9.  For  a  wound  of  the  Foot,  spread  out  a 
bandage  unfolded,  place  the  foot  on  the  centre 
of  it  with  the  toes  toward  the  point,  draw  the 
point  upward  over  the  instep ;  take  one  of  the 
ends  in  each  hand  close  up  to  the  foot,  bring 
them  forward  round  the  ankle  to  the  front  and 
over  the  point,  cross  them  on  the  instep,  carry 
tJie  ends  back  round  the  ankle,  cross  them  be- 
hind, catching  the  lower  border  of  the  bandage, 
bring  them  forward  again  and  tie  in  front  on  the 
ankle;  now  draw  the  point  well  over  the 
knot  and  pin  it  to  the  bandage  below.  (Fig. 
16.) 

20.  For  a  wound  of  the  Lower  Part  of  the 
Abdomen  or  of  the  Perinseum,  the  bandage  may 
be  applied  in  two  ways  : — 

(I)  Apply  the  bandage  unfolded  with  its  lower 
border  uppermost  and  the  centre  of  the  bandage 
well  over  the  front  of  the  lower  part  of  the  ab- 
domen ;  pass   the  two  ends   backward   and  tie 


3G 


FIRST  AID   TO   THE  INJURED 


them  behind ;  draw  the  point  down  to  tighten 
the  bandage ;  then  carry  it  between  the  legs, 
draw  it  up  well  behind  and  tie  it  to  the  ends. 
(Fig.  17.) 


Fig.  17 —The  triangular  bandage 
for  the  lower  part  of  the  Ab- 
domen. 


Fig.  18.- 


The  iriiiugiilar  bandage 
for  the  Groin. 


(II)     Tie  one  bandage  folded  narrow  just  above 
the  hips,  like  a  waist   belt ;  take  another   band- 


THE  APPLICATION  OF  BANDAGES  37 

age  also  folded  narrow,  pass  one  end  beneath 
the  waist  bandage  at  the  centre  of  the  back,  fold 
it  over  and  pin  it,  then  bring  the  other  end  for- 
ward between  the  thighs,  pass  it  under  the  waist 
bandage  in  front,  fold  it  over  and  pin  it. 

21.  For  a  wound  in  the  Groin,  tie  two  band- 
ages folded  narrow  end  to  end ;  apply  the  centre 
of  this  double  bandage  to  the  back  of  the  thigh, 
just  below  the  buttock,  bring  the  ends  forward, 
cross  them  over  the  pad  on  the  wound  in  the 
groin,  carry  them  back  above  the  hips,  and  tie 
in  front.     (Fig.  18.) 

22.  For  the  Stump  of  a  Limb,  lay  the  bandage 
unfolded  below  the  stump  with  the  lower  border 
upward,  draw  the  point  well  over  the  stump ; 
bring  the  ends  forward,  cross  them  over  the 
point,  carry  them  back,  again  cross  them,  bring 
them  forward  and  tie  in  front ;  now  draw  the 
point  forward  well  over  the  knot  and  pin  it  to 
the  bandage  below.     (Fig.  19.) 

The  Triangular  Bandage  for  Fractures 

The  Triangular  bandage  may  be  used 
I.     For  putting  up  the  following  Fractures : — 
(I)     Fracture  of  the  Jaw. 
(II)     Fracture  of  the  Ribs. 


38 


FIRST  AID   TO    THE  INJURED 


(III)     Fracture  of  the  Clavicle. 
(lY)     Fracture  of  the  Pelvis. 
{See  Chapter  Y,  Fractures.) 


Fig.  19.— The  triangular  bandage  for  a  Stump 

2.  For  fixing  Splints  to  Limbs. — If  it  is  re- 
quired to  secure  splints  to  the  arm,  forearm, 
wrist,  leg  or  ankle,  the  bandage  should  be  used 
folded  narrow ;  if  splints  are  to  be  tied  to  the 
thigh   or  knee,  the   bandage   should   be   folded 


THE  APPLICATION  OF  BANDAGES  39 

broad.     Either  of  the  following  methods  may  be 
adopted  : — 

(I)  First  adjust  the  splints  to  the  limb,  now 
raise  and  steady  the  limb  ;  then  place  the  centre 
of  the  bandage  folded  either  narrow  or  broad,  as 
the  case  may  be,  over  the  outer  splint  at  the 
spot  where  it  is  to  be  tied,  pass  the  two  ends 
round  the  limb,  cross  them  on  the  inside,  bring 
them  forward  and  tie  on  the  outside  over  the 
centre  of  the  splint. 

(II)  By  the  Looped  Triangular  handage, 
which  is  applied  as  follows :  Take  a  triangular 
bandage  folded  narrow  or  broad,  double  it  length- 
ways upon  itself ;  then,  after  adjustmg  the  splints 
to  the  limb,  raise  and  steady  it,  and  place  the  loop 
from  above  upon  the  outer  splint  at  the  spot 
where  the  splints  are  to  be  tied,  carry  the  ends 
round  the  limb  from  without  inward,  then  pass 
both  ends  through  the  loop,  one  from  right  to 
left  and  the  other  in  the  opposite  direction ;  now 
tighten  the  bandage  by  steadily  drawing  on  the 
two  ends,  and  then  tie  over  the  centre  of  the 
splint.  The  advantage  of  this  method  is  that 
splints  can  be  easily  fixed  without  unduly  dis- 
turbing the  parts.  Wote. — Always  fix  splints  to 
the  limb  first  above  the  seat  of  fracture. 


40  first  aid  to  the  injured 

The  Triangular  Bandage  to  Arrest  Hem- 
orrhage 

Here  the  Triangular  bandage  may  be  used : — 

1.  To  Improvise  a  Tourniquet. 

2.  To  Bandage  the  Limbs  to  each  other  in 
the  Method  of  Forced  Flexion.  (For  these,  see 
chapter  XI,  Hgemorrhage.) 

3.  As  a  Knotted  or  Twisted  Bandage.  This 
method  of  apphcatiun  is  described  above  (see 
Wound  of  Temple,  page  22). 

4.  For  Venous  Haemorrhage.  To  tie  round  a 
lim  b. 

Catitio7i. — After  bandaging  for  haemorrhage, 
do  not  in  the  absence  of  the  surgeon  Leave  a 
tight  bandage  on  for  more  than  three  hours. 


II.     THE     ROLLER    BANDAGE    AND     ITS 
APPLICATION 

The  Eoller  Bandage  is  essentially  the  bandage 
for  use  in  all  cases  where  it  is  required  to  main- 
tain firm  pressure,  e.  g.,  to  control  bleeding,  to 
fix  dressings  after  operations,  etc.  For  emer- 
gency cases  in  non-professional  hands  the  Koller 
is  not  so  well  adapted  as  the  Triangular,  as  it  re- 


THE  APPLICATION   OF  BANDAGES  41 

quires  for    its   proper   application    considerable 
skill  and  experience. 

KoLLER  Bandages  May  Be  Divided  Into  — 

1.  Elastic  Bandages.—These  are  of  several 
kinds,  woven,  India  rubber,  etc ;  they  are  used  to 
check  the  flow  of  blood  when  drawn  tightly 
round  a  part  and  to  give  support,  as  in  varicose 
veins. 

2.  Semi-elastic  Bandages. — These  are  made 
out  of  flannel,  domette,  silk,  cotton,  net,  etc.  As 
they  lie  more  smoothly,  they  are  easy  to  apply 
and  do  not  want  reversing. 

3.  Non-elastic  Bandages. — These  are  made  out 
of  gray  sheeting,  unbleached  or  bleached  calico, 
linen,  etc.,  and  are  the  roller  bandages  in  general 
use 

The  Sizes  of  the  Roller  Bandages  for  Adults  are  as 
Follows  : 


Part 

Breadth 

Length 

'the  Head 

- 

2  to  2i  ins. 

5  to  7  yards 

"      Finger 

- 

fin. 

-      1  to  2     " 

"      Hand       - 

- 

lin. 

••      4  to  5     " 

"      Arm 

_ 

H  to  2^  ins. 

-      8  to  12  " 

"      Shoulder 

- 

2|  to  3  ins. 

-      8  to  12  " 

"      Chest  or  Abdomen 

3  to  4  ins. 

-      6  to  8     " 

"      Leg  or  Thigh 

- 

2i  to  3  ins. 

-    10  to  12  " 

"      Foot 

- 

2^  ins. 

4     " 

42  FIRST  AID   TO   THE  INJURED 

To  Roll  the  Bandage. — Turn  in  enough  of  one 
end  to  start  the  roll,  place  the  bandage  upon  the 
thigh  with  the  part  rolled  near  the  groili,  and 
roll  the  cylinder  with  the  palm  of  the  hand  upon 
it  from  above  downward.  When  the  roll  is 
completed  insert  a  couple  of  pins  in  it. 

The  Named  Parts  of  the  Bandage  Are : — The 
initial  or  free  end ;  the  rolled  up  or  terminal 
end ;  and  the  body.  When  a  bandage  is  rolled  up 
from  one  end  only  it  is  termed  a  single-roller, 
when  rolled  up  from  both  ends  a  double  roller. 

Points  to  be  Observed  in  the  Application 
of  the  koller  bandage 

(I)  Before  applying  the  bandage  see  that  it  is 
tightly  rolled. 

(II)  Stand  in  front  of  the  limb  to  be  band^ 
aged,  and  place  it  in  the  exact  position  in  which 
it  is  to  be  kept,  if  it  is  the  upper  limb  bend  the 
elbow,  and  place  the  hand  with  the  thumb  point- 
ing upward. 

(III)  Commence  by  applying  the  outside  of 
the  bandage  to  the  inside  of  the  limb  and  then 
taking  a  couple  of  turns  round  the  limb  to  fix 
the  bandage. 


THE  APPLICATION  OF  BANDAGES  43 

(IV)  Always  bandage  from  below  upward,  ex- 
cept when  otherwise  indicated. 

(Y)  Always  bandage  from  within  outward, 
over  the  front  of  a  limb. 

(YI)  While  bandaging,  never  unroll  more  than 
two  or  three  inches  of  the  bandage  at  a  time. 

(YII)  Let  each  succeeding  turn  of  the  bandage 
overlap  two-thirds  of  the  preceding  turn. 

(YIII)  Bandage  the  part  firmly  but  never  too 
tightly,  or  too  loosely ;  if  the  edges  turn  up  on 
running  the  hand  down  a  bandage  after  it  has 
been  applied,  is  shows  that  the  bandage  is  too 
loose. 

(IX)  Use  firm,  equable  pressure  throughout 
the  bandage ;  if  when  the  bandage  is  removed 
red  lines  are  seen  on  the  surface  of  the  skin,  it  in- 
dicates that  unequal  pressure  has  been  exerted 
by  the  bandage. 

(X)  In  bandaging  a  limb,  leave  the  tips  of  the 
fingers  and  of  the  toes  uncovered,  in  order  to  see 
that  the  bandage  has  not  been  applied  too  tightly ; 
if  the  tips  become  blue  and  cold  loosen  the 
bandage. 

(XI)  Apply  the  bandage  smoothly,  leaving  no 
wrinkles. 

(XII)  Keep  all  the  margins  parallel,  and  keep 


44  FIRST  AW   10   THE  INJURED 

the  crossings  and  reverses  in  one  line,  and  toward 
the  outer  side  of  the  limb. 

(XIII)  Never  reverse  the  bandage  over  a  sharp 
bone. 

(XIV)  Always  form  a  figure  of  8  over  a  joint, 
(XY)     Never  apply  a  bandage  wet ;  when  dry 

it  will  shrink  and  bind  the  limb  too  tightly. 

(XVI)  End  by  fixing  the  bandage  securely 
with  a  safety  pin. 

(XYII)  Never  re-apply  a  bandage  without 
first  completely  winding  it  up. 

(XVI II)  In  taking  off  a  bandage  gather  the 
slack  into  a  loose  bundle,  and  pass  it  round  and 
round  the  part  from  which  it  is  being  removed. 

The  Roller  Bandage  May  be  Applied  in 
THE  Following  Ways: 

(I)  As  a  Circular  bandage. 

(II)  As  a  Simple  Spiral  bandage. 

(III)  As  a  Reversed  Spiral  bandage. 

(IV)  As  an  Oblique  bandage. 

(V)  As  a  figure  of  8  bandage  and  its  modifi- 
cation the  Spica. 

I.  The  Circular  Bandage  consists  of  a  series 
of  turns  made  round  a  part,  each  turn  exactly 
overlapping  the  one  preceding  it. 


THE  APPLICATION  OF  BANDAGES 


45 


2.  The  Simple  Spiral  Bandage  consists  of  a 
series  of  spiral  turns,  each  turn  overlapping  the 
preceding  one  by  about  two-thirds.  It  can  only 
be  applied  to  those  parts  which  vary  but  slightly 


Fig.  20.— The  Simple  Spiral. 


Fig.  21.— The  Reverse  Spiral. 


in  their  circumference,  such  as  the  forearm  just 
above  the  wrist,  and  the  fingers.     (Fig.  20.) 

3.  The  Reverse  Spiral  Bandage  consists  of  a 
series  of  spiral  turns  in  which  the  bandage  is  re- 
versed upon  itself  while  it  is  being  applied,  the 
object  of  reversing  being  to  make  the  bandage 
lie  smoothly  and  firmly  over  parts  which  vary 


46  FIEST  AID   TO   THE  INJURED 

considerably  in  diameter — such  as  the  upper  part 
of  the  forearm,  the  calf,  etc. 

To  Reverse  jproceed  as  follows :  First  take  a 
couple  of  spiral  turns  round  the  limb,  then  hold- 
ing the  head  of  the  bandage  lightly  in  one  hand, 
place  the  thumb  of  the  disengaged  hand  over  the 
lower  border  of  the  bandage,  on  the  outer  side 
of  the  limb ;  now  slacken  about  three  inches  of 
the  bandage,  turn  it  over,  reverse  it  downward, 
pass  it  under  the  limb  to  the  opposite  side,  keep- 
ing its  lower  edge  parallel  with  that  of  the  turn  be- 
low ;  when  the  outer  side  of  the  limb  is  reached 
make  the  reverse  again,  and  so  on.     (Fig.  21.) 

This  bandage  is  firmer  than  the  simple  spiral 
and  is  to  be  preferred  for  fixing  splints  to  a  limb. 
Its  disadvantages  are  that  it  is  somewhat  liable 
to  slip,  and  it  is  not  elastic. 

4.  The  Oblique  Bandage  consists  of  a  series  of 
rapidly  ascending  spirals  which  pass  up  the  limb 
without  their  edges  overlapping.  It  is  used  only 
for  holding  dressings  loosely  in  place. 

5.  The  Figure  of  8  Bandage  consists  of  a  series 
of  loops,  each  loop  forming  a  figure  of  8,  and 
overlapping  the  one  below  by  about  two-thirds 
the  width  of  the  bandage. 

To  Ajp]^ly  the  figure  of  8  Bandage  to  a  part, 


THE  APPLICATION  OF  BANDAGES  47 

6.^.,  the  back  of  the  hand,  proceed  as  follows: 
Take  a  couple  of  turns  round  the  wrist  to  fix  the 
bandage,  then  carry  the  bandage  from  the  thumb 
side  of  the  wrist  across  the  back  of  the  hand  to  the 
base  of  the  little  finger,  then  across  the  palm  at 
the  root  of  the  fingers,  then  obliquely  across  the 
back  of  the  hand  to  the  outer  side  of  the  wrist, 
then  across  the  palm  at  the  root  of  the  fingers 
and  again  obliquely  over  the  back  of  the  hand 
toward  the  root  of  the  little  finger,  leaving  about 
one-third  of  the  first  loop  uncovered,  then  again 
across  the  palm  and  over  the  back  of  the  hand  to 
the  wrist.  Eepeat  these  turns  about  three  times, 
taking  care  that  the  loops  overlap  each  other  by 
about  one-third  the  width  of  the  bandage,  and 
finally  fix  the  bandage  with  a  circular  turn  round 
the  wrist.     (Fig.  22.) 


Fig.  22.— The  Figure  of  8. 


The  figure  of  8  bandage  is  employed  chiefly  in 
the  neighborhood  of  joints;  it  is  less  firm  but 


48  FIEST  AID   TO    THE  INJURED 

jiiuic  elastic  than  the  reverse  spiral  band- 
age. 

The  Sjjica  Bandage. — This  is  a  modification  of 
the  Figure  of  8  bandage,  having  one  loop  much 
larger  than  the  other.  It  is  used  to  retain  dress- 
ings, and  to  keep  up  pressure  on  a  joint. 

There  are  two  methods  of  applying  the  Spica, 
viz.  : — 

(i)  The  Ordinary  Spica  which  is  used  at  the 
junction  of  a  limb. 

(ii)  The  Divergent  Spica,  which  is  used  to 
cover  in  large  prominences,  such  as  the  heel,  the 
bend  of  the  knee,  and  the  elbow. 

The  Spica  Bandage  for  the  Groin  may  be  em- 
ployed either  from  below  upward  as  an  "  ascend- 
ing spica,"  or  from  above  downward  as  a  "de- 
scending spica." 

(I)  The  Ascending  Spica. — Begin  by  first 
slightly  flexing  the  hip  on  the  side  of  the  affected 
groin,  then  with  a  bandage  2^  to  3  ins.  wide 
and  10  to  12  yards  long,  take  a  couple  of  s})ii'al 
turns  round  the  upper  fourth  of  the  thigh,  now 
make  reverses  up  the  thigh  till  the  groin  is 
reached ;  then  carry  the  bandage  across  the 
front  of  the  groin  outward  and  upward  to  a 
little  above  the  hip  joint,  then  across  the  small 


THE  APPLICATION  OF  BANDAGES 


49 


of  the  back,  and  over  the  hip  on  the  opposite  side 
to  the  front  of  the  abdomen,  and  across  the 
pubes  back  again  to  the  affected  groin,  then  to 
the  outside  of  the  thigh  round  the  back  of  it  to 
the  inside,  and  over  the  groin ;  again  across  tiie 
body,  and  so  on,  making  each  turn  go  about 
half-an-inch  higher  than  the  lower  edge  of  the 
preceding  turn,  and  finally  fix  with  a  safety  pin. 
(Fig.  23.) 


Fig.  23.— The  "Ascending  Spica' 
for  tlie  Groin. 


Fig.  24.— The  "  Descending 
Spica"  for  the  Groin. 


(II)     The  Descending  Spica. — Flex  the  thigh 

as  before,  then  lay  the  free  end  of  the  bandage 

over  the  affected  groin;  now  carry  the  bandage 

roni  within  outward  across  the  hip  on  the  same 


50  FIRST  AID   TO   THE  INJURED 

side,  taking  care  that  it  lies  as  high  as  possible 
(i.  e.^  just  below  the  brim  of  the  pelvis) ;  then 
pass  it  horizontally  across  the  loins  and  round 
the  hip  on  the  sound  side,  then  bring  it  obliquely 
across  the  front  of  the  abdomen  below  the  navel, 
over  and  round  the  thigh,  and  then  again  across 
the  affected  groin  back  to  the  first  turn,  and  so 
on,  causing  each  turn  to  lie  on  a  lower  level  than 
the  preceding  turn  and  to  overlap  it  by  about 
two-thirds  the  width  of  the  bandage.     (Fig.  24.) 

The  Spica  for  the  Shoulder  may  also  be  applied 
in  two  ways  ; — 

(I)  From  helow  Upward^  as  an  "ascending 
spica,"  thus :  Take  a  bandage  2^  to  3  ins.  wide 
and  8  to  12  yards  long,  make  a  couple  of  spiral 
turns  from  within  outward  round  the  upper 
third  of  the  arm  on  the  affected  side,  now  make 
reverses  up  the  arm  till  the  shoulder  is  reached  ; 
then  (after  first  placing  a  little  cotton  wool  in 
both  armpits),  carry  the  bandage  behind  the 
shoulder  across  the  back  to  the  opposite  side  and 
under  the  armpit  on  that  side,  then  across  the 
front  of  the  chest  well  up  toward  the  top  of  the 
breast  bone,  then  across  the  shoulder  in  a  line 
with  the  reverses  upon  the  bandage,  then  round 
the  arm   below  the   shoulder  from  behind  for 


THE  APPLICATION  OF   BANDAGES 


51 


ward  to  the  front,  and  then  across  the  back,  and 

so  on.     (Fig.  25.) 


Fig. 25— The  "  Ascending  Spica "  for  the  Shoulder 

(II)  From  above  Downward.,  as  a  "descend- 
ing spica,"  thus :  After  bringing  up  the  band- 
age by  means  of  reverses  to  the  armpit,  carry  it 
over  the  front  of  the  shoulder  and  as  high  up  the 
neck  as  possible,  then  round  the  back  to  the  op- 
posite side ;  now  under  the  arm  on  that  side  and 
across  the  front  of  the  chest  and  the  front  of  the 
arm  on  the  affected  side ;  then  under  the  armpit 
and  over  the  shoulder  again  to  the  back,  but  this 


FIRST  AID    TO    THE  INJURED 


time  on  a  lower  level  than  the  preceding  turn, 
and  so  on.     (Fig.  26.) 


Fig.  26.— The  "  Descending  Spica  "  for  the  Shoulder. 

Spica  for  the  Female  Breast. — Take  a  bandage 
3  to  4  ins.  wide  and  6  to  8  yards  long,  lay  the 
free  end  of  it  about  four  inches  below  the  affected 
breast,  then  make  two  horizontal  turns  round  the 
body  to  fix  the  bandage  ;  now  carry  the  band- 
age under  the  affected  breast  and  over  the  op- 
posite shoulder,  then  down  the  back  and  again  to 
the  front  on  a  slightly  higher  level  than  the 
preceding  turn ;  then  horizontally  across  the 
body,  and  so  on,  till  the  whole  breast  is  covered, 


THE  APPJJCATION  OF  BANDAGES  53 

the  'liorizontal  and  oblique  turns  being  each  time 
on  a  little  higher  level. 

Spica  for  the  back  of  the  Thumb. — This  is  the 
regular  bandage  for  a  sprain  of  the  thumb  and 
for  liaBmorrhage  from  the  part.  Take  a  bandage 
not  more  than  ^  inch  wide  and  1  to  2  yards 
iong,  place  the  hand  with  the  palm  downward, 
lay  the  free  end  of  the  bandage  below  the  root 
of  the  thumb  and  carry  the  bandage  across  to 
the  back  of,  and  round  the  wrist  twice  to  fix  it; 
now  carry  it  upward  from  the  root  of  the  thumb 
to  between  the  thumb  and  forefinger,  then  round 
the  thumb  as  high  as  it  will  lie,  then  across  the 


Fig.  27— The  Spica  for  the  Back  of  the  Thumb. 

back   of  the  hand,  and   round   the  wrist,   back 
again   to   the   root  of  the  thumb ;    then  again 


54 


FIRST  AID   TO   THE  INJURED 


round  the  thumb,  covering  two- thirds  of  the 
former  loop,  then  across  the  back  of  the  hand, 
and  so  on ;  bring  the  loops  round  the  thumb  a 
little  nearer  the  wrist  each  time ;  finally  fix  the 
bandage  round  the  wrist  either  with  a  safety  pin, 
or  by  splitting  the  end  and  tying.     (Fig.  27.) 

Spica  for  the  Great  Toe. — 
This  is  applied  in  precisely  the 
same  way  as  the  above,  the 
ankle  taking  the  place  of  the 
wrist. 

Divergent  Spica  for  the  Heel. 
— Take  a  bandage  2%  inches 
wide  and  4  yards  long,  place 
the  free  end  of  it  across  the 
outer  ankle ;  carry  the  roller 
under  the  sole  to  the  inner 
ankle,  and  from  here  outward 
over  the  front  of  the  instep  to  the  point 
from  where  the  bandage  started ;  now  carry  the 
bandage  over  the  heel  (placing  the  middle  of  the 
bandage  over  the  most  projecting  part  of  it),  then 
inward  and  across  the  front  of  the  instep,  and 
then  under  the  sole  of  the  foot,  catching  the 
lower  edge  of  the  loop  which  passes  over  the 
heel;  now  take  the  bandage  over  the  front  of 


Fig.  28.— Divergent 
Spica  for  the  Heel. 


THE  APPLICATION  OF  BANDAGES  56 

the  instep,  then  above  the  point  of  the  heel,  and 
over  the  upper  loose  edge  of  the  loop  which  goes 
over  the  heel,  back  to  the  instep  and  again  over 
the  lower  part  of  the  heel,  and  so  on,  each  loop 
over  the  point  of  the  heel  being  a  little  further 
from  the  preceding  one.  Finish  with  a  couple 
of  spiral  turns  round  the  lower  part  of  the  leg. 
(Fig.  28.) 
Divergent  Spica  for  the  Elbow.— Take  a  band- 


Fig.  29.— Divergent  Spica  for  tlie  Elbow. 

age  1%  to  2>^  ins.  wide  and  4  yards  long,  first 
flex  the  elbow,  then  carry  the  roller  up  the  fore- 
arm by  means  of  reverses  till  the  elbow  is 
reached,  now  place  the  middle  of  the  bandage 
well  over  the  point  of  the  elbow,  then  carry 
it  from  within  outward  and  catch  the  lower 
loose  edge  of  the  loop  which  encircles  the  point  of 
the  elbow,  then  take  the  bandage  across  to  the 
inner  side  of  the  elbow,  bring  it  from  within 
outward  again,  and  catch  the  upper  loose  edge 


56  FIRST  AID    TO    THE  INJURED 

of  the  loop  ;  continue  these  figures  of  S  from 
within  outward  alternately,  making  each  overlap 
two-thirds  of  the  preceding  one.  This  bandage 
is  emj)loyed  when  it  is  required  to  keep  the  fore- 
arm in  a  bent  position,  as  after  fractures  and  in- 
juries about  the  elbow  joint.     (Fig.  29.) 

Divergent  Spica  for  the  Knee. — First  slightly 
flex  the  knee,  then  lay  the  free 
end  of  a  bandage  2^  to  3  ins. 
wide  and  about  4  yards  long, 
against  the  inner  side  of  the 
knee  and  carry  the  roller  over 
the  front  of  the  knee-cap  to  the 
outer  side  of  the  knee  ami  then 
back  to  the  starting  point ;  then 
across  the  front  of  the  knee, 
catching  the  lower  loose  margin 
of  the  turn  above,  then  back  to 
the  starting  point,  and  again 
across  the  front  of  the  knee, 
i^2(7. 3o.-Divergent  Spica  this   time   catchiuff   the  upper 

for  the  Knee,  ,  .         p    .1       r.      ^  / 

loose  margm  or  the  nrst  turn  ; 
continue  these  figures  of  8  above  and  below  alter- 
nately.    This  bandage  is  used  to  give  support  to 
the  knee  joint  when  it  is  inflamed.     (Fig.  30.) 
To  Bandage  the  Upper  Extremities  proceed  as 


THE   A  r  rue  AVION   OF  BANDAGES 


57 


follows  :  Take  a  bandage  2j/  inches  wide  and  10 
to  12  yards  long,  make  a  couple  of  spiral  turns 
round  the  wrist,  beginning  at  the  root  of  the 
thumb  and  passing  outward  over  the  back  of  the 
wrist ;  then  carry  the  bandage  downward  over 
the  back  of  the  hand  to  the  root  of  the  little 
finger ;  now  take  one  turn  round   the   fingers, 


Fig.  31.— The  Upper  Extremity  Bandaged. 

leaving  the  tips  free,  then  make  a  figure  of  8 
round  the  back  of  the  hand,  and  repeat  it  three 
or  four  times ;  then  carry  the  bandage  by  spiral 
turns  upward  till  the  thick  part  of  the  forearm 
is  reached,  then  apply  the  reverse  spiral  till  the 
bulging  of  the  forearm  begins  to  diminish,  now 
flex   the   elbow,    make  a  figure  of  8  round  it, 


58  FIRST  AID   TO   THE  INJURED 

leaving  the  point  free,  unless  it  is  injured,  in 
which  case  cover  it,  then  make  a  few  spiral  turns 
round  the  lower  part  of  the  upper  arm,  then 
carry  the  bandage  up  by  reverse  spirals  to  the 
armpit,  and  secure  the  end  with  a  safety  pin. 
(Fig.  31.) 

Note. — Never  bandage  the  forearm  and  arm 
in  a  straight  position  and  then  flex  the  elbow 
afterward,  as  this  will  produce  compression 
of  the  veins  and  lead  to  swelling  of  the 
hand  and  fore  arm,  and  subsequent  mortitica- 
tion. 

Finger  Bandage ; — 

The  Continuous  Finger  Bandage. — Take  a 
bandage  %  inch,  or,  still  better,  ^  inch  wide, 
and  4  yards  long.  Make  a  turn  round  the  wrist 
leaving  about  6  ins.  of  the  end  free,  carry  the 
bandage  over  the  back  of  the  hand  to  the  outer 
side  of  the  little  finger,  with  a  single  turn  take  it 
well  up  to  the  level  of  the  nail,  then  make  spiral 
turns  round  the  finger  to  the  root,  then  carry  the 
bandage  across  the  back  of  the  hand  round  the 
wrist,  and  again  across  the  back  of  the  hand  to 
the  root  of  the  ring  finger,  now  proceed  success- 
ively with  this  and  each  of  the  other  fingers, 
covering   them   in   the   same  way  as   the   little 


2'HE  APPLICATION  OF  BANDAGES  59 

finger  till  all  are  covered,  and  then  tie  the  band- 
age with  the  loose  end  (Fig.  32).     This  bandage 


Fig.  32.— The  Continuous  Finger  Bandage. 

is  used  to  prevent  swelling  of  the  hand  when 
splints  and  dressings  are  applied  to  the  forearm. 
It  should  always  be  applied  before  other  band- 
ages are  put  on  higher  up.  It  is  also  of  great  use 
for  burns  and  scalds  of  the  fingers.  Any  one 
finger  may  be  bandaged  in  a  similar  manner  to 
the  above. 

To  Bandage  the  Lower  Extremity  proceed  as 
follows :  Take  a.  2}4  inch  bandage,  10  to  12  yards 
long.  Extend  the  leg  and  place  the  foot  at  right 
angles  to  it ;  lay  the  free  end  of  the  bandage  over 


60 


FIRST  AID    TO    THE  INJURED 


the  inner  ankle,  now  cany  the  roller  over  the 
instep  to  the  root  of  the  little  toe,  then  across  the 
sole  of  the  foot  to  the  ball  of 
the  great  toe,  then,  over  the 
instep  and  the  outer  ankle, 
round  the  back  of  the  heel, 
across  the  inner  ankle  and 
over  the  front  of  the  instep 
to  the  root  of  the  little  toe, 
then  across  the  sole  of  the 
foot  to  the  ball  of  the  great 
toe,  and  then  across  the  top 
of  foot  at  the  base  of  the 
toes  round  the  sole  of  the 
foot  and  back  again  to  the 
ball  of  the  great  toe ;  now 
make  two  reverses  round  the 
lower  part  of  the  foot,  these 
reverses  being  opposite  the 
middle  of  the  top  of  the  foot, 
then  make  two  figure  of  8  turns  round  the  ankle 
;ind  heel,  then  make  three  spiral  turns  round  the 
h)wer  part  of  the  leg  and  ankle,  then  carry  the 
bandnge  upward  by  reverse  spirals  till  the  knee 
is  reached,  now  make  figure  of  8  turns  round  the 
knee  joint,  either  covering  it  in  or  leaving  it  free, 


Fig. 


33.— The  Lower  Limb 
Bandage. 


THE  APPLICATION   OF  BANDAGES  61 

then  carry  the  bandage  up  the  thigh  by  reverse 
spirals,  finish  and  secure  the  end  with  a  safety 
pin.     (Fig.  33.) 

Bandages  for  the  Head. 

(I)  The  Capeline  Bandage,— T^lVq  two  roller 
bandages,  one  2  ins.  wide  and  6  yds.  long,  the 
other  1%  ins.  wide  and  5  yds.  long.  Sew  the 
free  ends  together,  this  will  form  a  double-headed 
roller.  Make  the  patient  sit  on  a  low  chair, 
stand  behind  him  holding  the  wide  roller  in  the 
right  hand  and  the  narrow  roller  in  the  left 
hand ;  now  place  the  middle  of  the  double- 
headed  roller  against  the  centre  of  the  forehead, 
and  carry  the  roller  backward  one  on  each  side 
above  the  ears,  and  below  and  behind  the  occiput, 
cross  hands  passing  the  narrow  roller  over  the 
wide  one,  now  change  rollers  taking  the  wide 
roller  in  the  left  hand  and  the  narrow  roller  in 
the  right  hand  ;  draw  the  bandage  tight,  carry 
the  wide  roller  upward  along  the  top  of  the  middle 
of  the  head  to  the  root  of  the  nose,  and  bring  the 
narrow  roller  horizontally  forward  above  the  right 
ear,  and  across  the  wide  roller  at  the  root  of  the 
nose;  now  carry  the  wide  roller  back  across 
the  top  of  the  head  a  little  to  the  left  of  the 
middle  line  (Fig.   S-i),   fix  it  behind  as  in  front 


62 


FIRST  AID   TO   THE  INJURED 


Fig.  34. 


Fig.  34a.  Fig.  Ub. 

Figs.  34,  34a,  346.— The  Capeliue  Bandage. 


THE  APPLICATION  OF  BANDAGES  63 

by  the  narrow  roller,  then  bring  it  over  to  the 
front  across  the  head  a  little  to  the  right  of  the 
middle  line  (Fig.  34^),  again  fix  it  by  the  narrow 
roller,  and  continue  these  operations  backward 
and  forward,  each  time  making  the  bandage 
which  is  covering  the  top  of  the  head  diverge  a 
little  from  the  middle  line  till  the  ears  are  reached  ; 
now  cut  off  the  vertical  bandage  in  front,  and  fix 
by  taking  two  extra  turns  with  the  horizontal 
bandage  round  the  head  and  pinning  on  one  side. 
(Fig.34J.) 

This  bandage  is  used  for  fixing  dressings  on 
the  head.  Its  disadvantages  are:  that  it  is 
troublesome  to  apply  ;  it  is  hot,  and  if  put  on  too 
tightly  it  becomes  painful. 

(II)  The  Twisted  or  Knotted  Bandage. — Take 
a  bandage  2^  inches  wide  and  8  yards  long,  un- 
roll it  for  about  1  foot,  hold  the  free  end  in  the 
left  hand ;  place  the  bandage  against  the  left 
temple,  carry  the  roller  round  the  forehead, 
across  the  opposite  temple,  then  below  the  occi- 
put, and  bring  it  back  to  the  unrolled  end,  now 
twist  it  round  this  end  sharply,  and  carry  it 
vertically  upward  round  the  vertex  (Fig.  35) 
down  the  side  of  the  face  under  and  over  the  jaw 
till  the  unrolled  end  is  reached;  now  twist  it 


64  FIRST  AW    TO    THE  INJURED 

round  this  again,  and  carry  it  obliquely  midway 
between    the    two   preceding   turns   (Fig.   35{^), 


Fig.  35.  Fig.  35a 

Figs.  35,  35a,  .^%.— The  Twisted 


Fig.  Zlb 
n-  Knotted  Handage. 


round  the  head  to  the  starting  point ;  then  make 
another  twist  and  take  it  vertically  round  the 
head.  Repeat  these  oblique  and  vertical  turns 
alternately  till  sufficient  pressure  is  obtained,  and 
fix  the  bandage  by  knotting  the  two  ends  to- 
gether.    (Fig.  35?a) 

This   bandage  is  used   to  exert  pressure  on  a 
graduated  compress  placed  over  a  bleeding  wound 


THE   APPLICATION  OF  BANDAGES  Or, 

of  Liiu  temple,  and  for  retaining  dressings  on  the 
front  of  the  head. 

To  Bandage  the  Chest. — A  bandage  applied  to 
the  chest  has  a  tendency  to  slip  down ;  to  avoid 
this  a  brace  is  used  and  the  bandage  is  applied 
from  below  upward.     Therefore  proceed  as  fol- 


Fig.  36.  Fig.  36a 

Figs.  36,  36a.— The  Cliest  Bandage. 


lows :  Take  a  roller  6  inches  wide  and  G  to  8 
yards  long,  slit  the  free  end  down  the  centre  to 
about  2i^  feet,  place  the  bandage  with  the  roller 
touching  the  back  and  the  slit  ends  lying  well 
over  the  shoulders  and  in  front  of  the  chest,  now 


m 


FIRST  AID    TO   THE  INJURED 


turn  the  bandage  at  right  angles  at  the  lower  part 
of  tlie  back,  and  make  spiral  turns  over  tlie  free 
ends  and  round  the  chest  from  behind  forward, 
and  from  below  upward,  each  spiral  overlapping 
the  one  below  it  by  about  one  half  its  breadth 
(Fig.  36) ;  when  the  desired  level  is  reached  secure 
the  last  spiral  with  a  safety  pin  in  front  and  be- 
hind ;  now  double  the  free  ends  over  the  applied 
bandage  and  pin  each  end  to  the  corresponding 
.bandage  on  the  shoulder.     (Fig.  36^/.) 

To  Bandage  the  Abdomen,  proceed  in  the  same 
way  as  for  the  chest,  but  bandage  from  above 
downward.    This  bandage  is  best  made  of  flannel. 


Table  Showing  the  Kinds  of  Rolleu 

Bandage  to  be  Applied  to 

Different  Parts 


Part  to  be  Band- 
aged. 

Kind  of  Ba 
to  use 

ndage 

Object  of  the  Bandage 
Applied. 

I.  The  Head 

The  Capeline 
The         Twisted         or 
Knotted 

To  retain  dressings 

'lo  exert  pressure  on  a  gradu- 
ated compress  or  paii  placed 
over  bleeding  wound  and  to 

retain  dressings 

2.  The  Chest 

The  Spiral  - 

- 

To    give   support,   exert   pres- 
sure or  retain  dressings 

3,  The  Kieast 

4.  The  Abdomen   - 

The  Spica  - 
ihe  Spiral  - 

" 

To  give  support 
To  give  support,  exert  pressure 
or  retain  dressings 

5,  The  '1  huiiib 

The  Spica  - 

■ 

For  sprain  of  the  thumb,  or  to 
arrest   haemorrhage  from  the 
part 

THE  APPLICATION  OF  PANDA GES 


67 


Par/  to  I'fi  Ba?ui- 
aeed. 


L'he  Fingers 


7.  The  Hand 

8.  The  Wrist 

9.  The  Forearm     - 
10.  The  Elbow 

(a)  To   cover  the 
point 


Kind  0/  Bandage 
to  use 


The  Spiral,  known  as 
the  Continuous  Fin- 
ger bandage 


The  Figure  of  8 

The  Spiral  - 

The  Reverse  Spiral 

The  Divergent  Spica 


Object  qfthe  Bandage 
Applied. 

To  retain  dressings,  especially 
in  case  of  burns  or  scalds,  or 
to  prevent  the  fingers  from 
swelling  when  splints  or 
dressings  are  applied  to  the 
forearm 

To  retain  dressings,  fix  splints, 
etc. 

Ditto 

Ditto 

To  keep  the  forearm  in  a  bent 
position,  as  in  fractures,  or  in 
injuries  about  the  elbow  joint 


(<5)  To   leave   the 

The  Figure  of  8 

To    retain    dressings   or   exert 

point  uncovered 

pressure 

II.  The  Upper  Arm 

(a)  For  the  lower 

The  Spiral  - 

To  retain  dressings,  fix  splints, 

part 

etc. 

(^)  For  the  upper 

The  Reverse  Spiral 

Ditto 

part 

12.  The  Shoulder 

The  Spica  - 

To  retain  dressings,  or  to  exert 
pressure 

13.  The  Great  Toe 

The  Figure  of  8 

For  sprains,  or  haemorrhage 
from  the  part 

14.  The  Foot 

The    Figure    of    8   fol- 

To  retain    dressings,   or   exert 

lowed   by   the   Spiral 

pressure,  or  fix  splints 

and       the       Reverse 

Spiral 

15.  The  Heel 

(rt)  To  cover  the 

The  Divergent  Spica 

Ditto 

point 

{b)  To    leave   the 

The  Figure  of  8 

Ditto 

point  uncovered 

16.  The  Ankle 

The  Spiral  - 

Ditto,  or  to  fix  splints 

17.  The  Leg 

The  Reverse  Spiral 

Ditto 

18.  The  Knee 

(«)  To  cover  it  in 

The  Divergent  Spica 

To  give  support  to  the  joint 
when  it  is  inflamed 

{b)  To     leave     it 

The  Figure  of  8 

To  retain  dressings 

uncovered 

19.  The  Thigh 

The  Reverse  Spiral 

To  retain  dressings,  or  to  fix 
splints 

20.  The  Groin 

The  Spica  - 

To  retain  dressings,  or  to  exert 
pressure 

68  FIRST  AID   TO   THE  INJURED 

BANDAGES      OF     SPECIAL      FORM     AND 
THEIR  APPLICATION 

1.  The  Square  Bandage. — This  is  used  as  a 
protection  for  the  entire  head  and  neck.  Take  a 
handkerchief  a  yard  square,  and  fold  in  two  so 
as  to  allow  the  under  layer  to  project  about  4 
inches  beyond  the  upper ;  lay  the  middle  of  the 
bandage  upon  the  top  of  the  head,  with  the 
larger  flap  covering  the  eyes,  the  margin  of  the 
upper  flap  in  a  line  with  the  eyebrows,  and  the 
short  borders  hanging  upon  the  shoulders  (Fig. 
37) ;  now  take  the  two  outer  corners,  pass  them 
below  the  inner  ends  and  tie  them  in  a  reef  knot 
firmly  under  the  chin  (Fig.  37^),  turn  the  border 
of  the  under  layer  over  the  forehead,  take  its  two 
corners,  carry  them  backward  and  tie  in  a  reef 
knot  behind  the  head.     (Fig.  37J.) 

2.  The  Four-Tailed  Bandage.— This  is  used  to 
keep  a  dressing  on  the  chin,  the  top,  back,  or 
front  of  the  head,  and  on  the  knee;  it  is  also 
used  for  a  broken  jaw. 

(I)  The  Fo%ir-Tailed  Bandage  for  the  Jaio. — 
Take  1  %  yds.  of  a  3-in.  roller,  make  a  longitudi- 
nal slit  in  the  centre  of  it  about  3  ins.  Ions:  and 
then  slit  down  the  ends  to  within  6  ins.  of  the 
centre.     Place  the  chin  in  the  centre  slit,  then 


THE  APPLICATION  OF  BANDAGES 


Fig.  37. 


Fig.  ^la.  Fig.  37&. 

Figs.  37,  37a,  37&.— The  8(iiiare  Bandage. 


70 


FIRST  AID   TO   THE  INJURED 


carry  the  two  lower  ends  to  the  top  of  the  head 
and  tie  them ;  carry  the  two  upper  ends  behind 
the  neck  and  tie  them  (Fig.  38) ;  now  tie  the 
ends  to  each  other  behind  the  head.     (Fig.  38a.) 


Fig.  38.  Fig.  38a. 

Figs.  38,  38a.— The  Four-tailed  Bandage  for  the  Jaw. 

(II)  The  Fotir- Tailed  Bandage  for  the  Read, 
the  "  four  tailed  cap."  Take  a  piece  of  calico  6 
to  8  ins.  wide  and  3  feet  long,  and  slit  up  the  ends 
to  within  2  inches  of  the  centre. 

{a)  To  apply  it  to  the  front  of  the  head : 
Place  the  centre  of  the  bandage  upon  the  top  of 
the  head,  carry  the  two  anterior  ends  backward 
over  the  ears  and  tie  them  below  the  occiput, 
then  carry  the  two  posterior  ends  forward  and 
tie  them  under  the  chin.     (Fig.  39.) 


THE  ArPLICATION  OF  BANDAGES 


{]))     To   apply  it   to   the   back   of   the  head : 
Place  the  centre  of  the  bandage  upon  the  back 


Fig.  39.  Fig.  39a. 

Figs.  39,  39a.— The  Four-tailed  Bandage  for  the  Head. 

of  the  head,  carry  the  two  u[)per  ends  downward 
and  tie  them  under  the  chin,  then  carry  the  two 
lower  ends  forward  and  tie  them  in  front  on  the 
forehead.     (Fig.  39».) 

(Ill)  The  Four-Tailed  Bandage  for  the  Knee. 
—Take  a  piece  of  calico  6  to  8  ins.  wide  and  3  ft. 
long,  and  slit  it  down  the  narrow  ends  to  within 
2  ins.  on  each  side  from  the  centre.  To  apply 
it :  Lay  the  centre  of  the  bandage  upon  the  knee- 
cap, cross  the  ends  behind  the  bend  of  the  knee, 
the  upper  ends  below  the  lower,  then  bring  the 


72 


FIRST  AID    TO    THE  INJURED 


ends  forward,  tie  the  two  upper  ones  above  the 
knee-cap  and  the  two  low^er  ones  below  it. 
(Fig.  40.) 

3.  The  Many-Tailed  Band- 
age (Bandage  of  Scultetus). 
— This  is  employed  in  cases 
where  it  is  advisable  not  to 
disturb  a  limb  more  than  is 
necessary.  For  the  bandage 
the  widths  required  are — ^]^ 
ins.  for  the  arm,  and  3j^  ins. 
for  the  leg.  To  make  the 
bandage :  Take  a  stiip  as 
k)ng  again  as  the  part  it  is 
required  to  cover,  spread  it 
out,  now  lay  strips  6  ins. 
longer  than  the  part  required 
to  be  covered  across  the 
upper  half  of  the  perpen- 
dicular strip,  with  their  centres  along  the 
centre  of  this  strip ;  make  these  cross  strips 
overlap  each  other  by  about  one-third  of  their 
width,  and  sew  them  to  the  perpendicular 
strip.  To  apply  the  bandage :  Lay  the  limb 
along  the  upper  half  of  the  central  strip,  draw 
the  lower  half  of  the  central  strip  over  the  front 


Fig.  40.— The    Foui-tailed 
Bandage  for  the  Knee. 


THE  APPLICATION  OF  BANDAGES 


73 


of  the  limb  (Fig.  41),  fold  the  cross  strips  over 
from  below  upward  somewhat  obliquely,  and 
secure  the  last  two  strips  to  the  two  below  by  a 
safety  pin.     (Fig.  4:1a.) 


Fig.i\.  Fig.iia. 

Figs.  41,  41a.— The  Many-tailed  Bandage. 


4.  The  T  Bandage. — This  is  used  to  retain 
dressings  on  the  perinaeum.  It  is  made  by  taking 
a  bandage  3  ins.   wide  by   ly^  yards  long,  and 


74 


FIRST  AID    TO    THE  INJURED 


sewing  it  at  right  angles  to  the  centre  of  a 
similar  strip  1  yard  long.  To  apply  the  band- 
age :  Pass  the  long  strip  round  the  waist  above 
the  hips,  so  that  the  short  strip  lies  along  the 
sacrum,  and  pin  the  ends  in  front ;  now  bring 
the  short  strip  forward  between  the  thighs  and 
pin  it  to  the  long  strip  in  front.     (Fig  42.) 


Fig.  42.— The  T  Bandage, 


CHAPTER  III 

lI.EMORRIIAGE    AND   ITS    IMMEDIATE   TREAT- 
MENT 

Hajinorrliage — DefiniMon,  Causes,  Situation,  Symptoms,  aud 
Varieties  of — The  Treatment  of  Capillary  Haemorrhage — 
The  Treatment  of  Venous  Haemorrhage — The  Treatment  of 
a  Bmst  Varicose  Vein — The  General  "First  Aid"  Treat 
ment  of  Arterial  Haemorrhage — First  Aid  Methods  of 
Controlling  Arterial  Haemorrhage— Digital  Compression, 
the  points  where  the  chief  vessels  may  be  digitally  com- 
pressed— Forced  Flexion  of  a  Limb,  Esmarch's  Band, 
Tourniquets  (Improvised,  Volker's,  Screw  and  Field) — The 
Treatment  of  Constitutional  Symptoms — The  Immediate 
Treatment  of  External  Haemorrhage — Internal  Haemor- 
rhage, its  Causes,  and  the  Means  to  be  adopted  for  its 
Treatment — Blood  Spitting,  Blood  Vomiting,  and  Nose 
Bleeding,  their  Causes  and  Treatment. 

Definition.— Hsemorrhage  may  be  defined  as 
tiie  escape  of  blood  from  the  heart  or  the  blood- 
vessels. 

The  Causes  are  : — (I)  Injury;  (II)  Disease. 

The  Situation. — Haoraorrhage  may  be  either  : — 

(I)  External. — This  is  most  frequently  the  re- 
sult of  injury. 

75 


7(J  FIRST  AID    TO    THE  INJURED 

(II)  Internal. — This  is  general  I  \^  due  to  disease 
affecting  the  blood-vessels,  or  their  neighboring 
structures. 

The  Symptoms  of  HaBinorrhage  are: — The 
actual  appearance  of  blood  (which  is  always 
seen  in  external  haemorrhage,  while  in  internal 
haemorrhage  blood  may  also  reveal  its  presence — 
e.  g.^  in  bleeding  from  the  lungs,  etc.),  and  the 
constitutional  effects,  more  or  less,  which  follow 
the  loss  of  blood,  i.  ^.,  the  signs  of  syncope  or 
fainting,  which  are  indicated  by  a  cold  and 
clammy  skin,  a  pallid  and  livid  face,  dilated 
pupils,  feeble  and  irregular  breathing,  an  irregular 
and  almost  imperceptible  pulse,  dizziness,  inclina- 
tion to  vomit,  and  loss  of  consciousness.  These 
constitutional  effects  are  in  direct  proportion  to 
the  suddenness  of  the  loss  of  blood,  i.  e.,  the 
quicker  the  loss  the  more  profound  the  syncope. 

Varieties  of  Haemorrhage. — The  severity  of 
the  bleeding  varies  with  the  portion  of  the 
vascular  circuit  which  is  wounded,  and  haemor- 
rhage presents  different  characteristics  according 
to  its  origin  from  capillaries,  veins  or  arteries 
respectively  : — 

1.  Capillary. — This  is  the  least  dangerous 
form  ;  it  is  indicated  by  a  general  oozing  from 


n.EMORRHA  GE  A  ND  ITS  IM MEDIA  TE  TREA  TMENT    77 

the  whole  surface  of  a  wound,  and  the  color  of 
the  blood  is  more  or  less  brick  red. 

2.  Venous. — This  is  indicated  by  the  blood 
flowing  in  a  continuous  stream,  and  issuing  from 
the  cut  end  of  the  vessel  furthest  from  the  heart, 
i.  e.^  in  the  limbs  from  below  the  wound,  the 
color  of  the  blood  being  a  dark  purple.  Venous 
haemorrhage  comes  next  in  seriousness  to 
arterial. 

3.  Arterial. — This  is  the  most  serious  form  of 
bleeding  ;  it  is  indicated  by  the  blood  flowing  in 
a  forcible  pulsatile  stream  (which  rises  with  each 
beat  of  the  heart  and  falls  in  the  interval),  and 
issuing  from  the  cut  end  of  the  vessel  nearest 
the  heart,  i.  e.^  in  the  limbs  from  above  the 
wound,  the  color  of  the  blood  being  a  briglit 
scarlet. 

EXTERNAL  HiEMORRHAGE 

I.  The  Treatment  of  Capillary  Haemorrhage. 
— Expose  the  part  to  the  air  and  apply  pressure 
to  the  wound  to  close  the  vessels,  and  prevent 
further  escape  of  blood.  This  may  be  done  by 
means  of  a  perfectly  clean  finger,  or  a  clean  bit 
of  sponge  or  lint.  If  the  above  means  are  not 
sufficient,    encourage    coagulation    of    blood,  so 


78  FIRST  AID   TO    THE  INJURED 

that  the  clot  may  seal  the  cut  vessels ;  this  may 
be  done  by  the  application  of  clean  cold  water, 
or  hot  water  at  a  temperature  of  100°  to  120° 
F.,  or  by  first  drying  the  part  and  then  applying 
a  styptic,  such  as  common  salt,  burned  or  dried 
alum,  tincture  of  steel,  turpentine,  tannic  or  gal- 
lic acid.  Friar's  balsam,  tincture  of  eucalyptus, 
etc. 

Note. — Styptics  are  not  to  be  applied  too 
strong,  otherwise  they  destroy  the  vitality  of 
the  tissues. 

2.  The  Treatment  of  Venous  Haemorrhage. — 
In  treating  bleeding  from  veins,  adopt  the  fol- 
lowing measures,  viz.  : — 

(I)  Remove  all  constrictions  which  impede 
the  backward  flow  of  blood  to  the  heart,  i.  e., 
all  tight  clothing  about  the  chest  and  neck  must 
be  loosened,  garters  undone,  etc. 

(II)  Elevate  the  bleeding  part  if  possible 
above  the  level  of  the  heart,  i.  e.,  if  the  bleeding 
is  from  a  limb,  raise  it. 

(III)  Apply  first  digital  pressure  (pressure 
with  perfectly  clean  fingers),  directl}^  to  the  sur- 
face of  the  wound,  and  then  place  a  clean  pad 
on  the  wound  and  keep  it  in  position  by  a  band^ 
age. 


HA'LMOURHA  GE  A  NI)  ITS  HTMEDIA  TE  TREA  TMENT    7i> 

(IV)  Keep  the  wounded  part  in  an  elevated 
position  (if  possible)  for  some  hours  after  the 
bleeding  has  stopped. 

The  Immediate  Treatment  of  a  Burst  Yari- 
cose  Vein. — The  superficial  veins  of  the  lower 
extremity  are  liable  to  become  dilated  or  vari- 
cose, from  the  incompetency  of  their  valves  and 
the  consequent  undue  pressure  of  the  column  of 
blood  upon  their  walls ;  these  dilated  veins  may 
burst,  producing  serious  or  even  fatal  haemor- 
rhage if  not  promptly  attended  to;  the  meas- 
ures therefore  to  be  adopted  in  dealing  with  a 
condition  of  this  description  are  as  follows  : — 
(I)     Place  the  patient  at  once  on  his  back. 

(II)  Kemove  all  constrictions  round  the  limb 
on  the  heart  side. 

(III)  Raise  the  wounded  leg. 

(IV)  Expose  the  bleeding  surface,  place  a 
clean  pad  directly  on  the  wound  and  fix  it,  by 
means  of  a  triangular  bandage. 

(V)  If  the  patient  has  to  be  removed,  carry 
him  on  a  stretcher,  lying  on  his  back  with  his 
foot  raised. 

(VI)  Keep  the  patient  in  a  recumbent  position 
with  the  foot  raised  for  some  hours  after  the  ac- 
cident. 


80  FIRST  AID   TO    THE  INJURED 

i\  1 1)  If  the  bleeding  has  been  at  all  excessive 
keep  the  patient  warm,  in  order  to  counteract 
any  sudden  failure  of  the  heart's  action. 

3.     Treatment   of    Arterial    Hsemorrhage In 

arterial  bleeding  the  force  of  the  heart's  beat 
pumping  the  blood  through  the  cut  vessel  ])re- 
vents  any  chance  of  clotting,  therefore  the  two 
main  factors  in  stopping  bleeding  are  : — 

(I)  To  place  the  bleeding  part,  if  possible,  in 
a  proper  position,  i.  e.^  above  the  level  of  the 
heart,  at  the  same  time  expose  the  wound  to  the 
air,  and  remove  all  constrictions  which  impede 
the  return  of  venous  blood. 

(IT)  To  apply  pressure  to  the  wound  itself  or 
to  the  main  artery  supplying  the  part.  Pressure 
shouhl  always  first  be  applied  with  the  thumb 
and  finger  (digital  pressure),  so  that  no  time  is 
lost  in  getting  appliances. 

To  aid  the  above  means,  the  patient  should  be 
kept  absolutely  quiet  and  in  a  recumbent  position. 

Sliould  there  be  any  constitutional  symptoms 
(syncope),  these  must  be  treated  {see  page 
193). 

"  First  Aid "  Methods  of  Controlling  Arterial 
Haemorrhage. — The  measures  to  be  adopted  will 
depend  npon  the  severity  of  the  bleeding. 


JUCMuh'R  11 A  GE  A  ND  ITS  IMMEDIA  TE  TEE  A  TMENT    81 

1.  If  tup:  Bleeding  is  not  Excessive, 
i.  e.,  in  iiU  superlicial  haemorrhages  apply  : — 

(I)  Firm  pressure  directly  to  the  bleeding- 
point  by  means  of  absolutely  clean  fingers,  and 
when  the  bleeding  has  quite  stopped,  place 

(II)  A  clean  pad  over  the  wound  and  keep  it 
in  position  either  by  means  of  a  folded  triangu- 
lar bandage,  or  by  a  roller  bamlage. 

In  some  situations,  e.  gr.,  the  palm  of  the  hand, 
a  graduated  compress  (made  by  superimposing 
several  layers  of  clean  lint  upon  each  other,  the 
smallest  piece  being  about  the  size  of  a  sixpence 
and  the  largest  that  of  a  shilling)  is  more  effect- 
ive than  a  simple  pad. 

2.  If  the  Bleeding  is  Excessive,  apply 
if  possible : — 

(I)  Digital  Comjjy'ession  (compression  by 
means  of  the  fingers)  to  the  main  artery  supply- 
ing the  part  with  blood.  This  pressure  is  ap- 
plied to  the  artery  between  the  wound  and  the 
heart,  and  at  a  point  where  some  hard  basis  of 
support  is  furnished,  against  which  the  artery 
can  be  pressed,  e.  g.,  where  the  vessel  passes  over 
or  along  a  bone. 

The  great  value  of  digital  compression  is  that 
it  can  be  applied  immediately.     In  digital  com- 


82  FIRST  AID   TO   THE  INJURED 

pression  the  following  points  are  to   be  remem- 
bered : — 

(ct)     To  use  the  thumb  to  make  the  pressure. 
{h)     Having  ascertained  the  position  of  the 
artery    by  its  pulsation,  get   it  fairly 
against   the    bone,  and    press   directly 
upon  it,  using  sufficient  force  just   to 
stop  the  bleeding  but  not  to  cause  the 
patient  any  pain. 
{c)     Compress   if    possible    the   artery  only, 
avoiding  all   adjacent  structures   such 
as  veins  and  nerves.     Digital  compres- 
sion is  onl}^  applicable  in  certain  parts 
of  the  body,  viz.,  the  limbs,  the  neck, 
and  some  parts  of  the  head  and   face, 
and  it  cannot  be  effectively  maintained 
by  one  person  for  more  than  about  lif- 
teen  consecutive  minutes  at  a  time. 
(II)    Replace  Digital  Coiiq^ression  by  applying 
a  hard  pad  upon    the  artery,  and  keeping  it  in 
position  by  a  bandage. 

The  follo'winy  vessels  may  he  digitally  com- 
pressed^ viz.  : — 

I.  The  Temporal  Artery. — This  passes  over 
the  zygoma,  and  may  be  best  compressed  at  a 
point  one  finger's  breadth  in  front  of  the  open- 


7<  E210ERHA  QE  A  KD  ITS  niMED TA  TE  TREA  T3TENT    83 

ino^  of  the  ear,  pressure  being   applied    directly 
ae:ainst  the  bone.     (Fig.  43.) 


Fig.  43.— Compression  of  the 
Temporal  Artery 


Fig.  44.— Compression  of  t.ie 
Occipital  Artery. 


2.  The  Occipital  Artery. — This  passes  over  the 
mastoid  process,  and  can  be  best  compressed  at 
a  point  two  fingers'  breadth  from  the  centre  of 
the  back  of  the  ear,  pressure  being  applied  di- 
rectly backward.     (Fig.  44.) 

3.  The  Facial  Artery. — This  passes  over  the 
lower  jaw,  and  can  be  best  compressed  at  a  point 
one  inch  in  front  of  the  angle  of  the  jaw,  pressure 
being  applied  directly  backward.     (Fig.  45.) 

4.  The  Common  Carotid  Artery. — This  passes 
along  the  side  of  the  neck,  from  a  point  midway 
between  the  angle  of  the  jaw  and  the  mastoid 


84 


FIRST  AID   TO   THE  INJURED 


process  to  the  sternal  end  of  the  clavicle;  it  can 
be  best  compressed  at  a  spot  one  and  a  half  inches 


Fig.  45.— Conipiession  of  the 
Facial  Artery 


Fig.  46.— Compression  ot  ilie 
Carotid  Artery 


above  the  joint  between  the  sternum  and  the 
clavicle,  pressure  being  applied  inward  and 
backward.     (Fig.  46.) 

5.  The  Subclavian  Artery. — This  passes  across 
the  upper  surface  of  the  first  rib ;  it  can  be  best 
compressed  at  a  point  behind  the  middle  of  the 
clavicle,  pressure  being  applied  downward  and 
backward  after  first  depressing  the  shoulder, 
either  with  the  thumb  (Fig.  47),  or  with  the  han- 
dle of  a  door  key  padded.     (Fig.  48.) 

6.  The  Axillary  Artery.— This  passes  over  the 
apex  and  along  the  outer  side  of  the  axilla;  it 


ILEMOERHA  GE  A  ND  ITS  IM3IEDIA  TE  TEE  A  TMENT    85 


can   be   best  compressed   at   the  junction  of  the 
outer  with  the  middle  third  of  the  armpit,  pres- 


Fig.  47.— Compression  of  the  Sub- 
clavian with  the  Tiiumb. 


Fig.  48.— Compression  of  Sub- 
clavian with  tlie  Handle  of 
a  Door  Key  Padded. 


sure  being  applied  outward  and  backward  after 
first  raising  the  arm.     (Fig.  49.) 

7.  The  Brachial  Artery. — This  passes  along 
the  inner  border  of  the  biceps  muscle,  in  a  line 
with  the  inner  seam  of  the  coat ;  it  can  be  best 
compressed  in  the  middle  of  the  arm,  pressure 
being  applied  outward  and  backward.     (Fig.  50.) 

8.  The  Radial  and  Ulnar  Arteries. — Tliese  pass 
alono'  the  outer  and  inner  borders  of  the  wrist 
respectively ;  they  can  be  best  compressed  at  a 
point  one  inch  above  the  wrist  on  each  side,  pres- 


86 


FIRST  AID   TO    THE  INJURED 


sure    being    applied    directly    backward.     (Fig. 
51.) 

The  Femoral  Artery. — This  passes  over  the  cen- 


Fig.  49.— Compression  of  Axillary  Artery. 

tre  of  the  pubes  (here  it  is  known  as  the  common 
femoral)  and  then  along  a  line  drawn  from  the 


Fig.  50.— Compression  of  the  Brachial  Artery. 

middle  of  the  bend  of  the  groin  to  the  back  of 
the   internal   condyle   of   the  femur  (here  it  is 


H.EMOBK  HA  GE  A  NI)  ITS  IM MEDIA  TE  TEE  A  TMENT    87 

known  as  the  superficial  femoral) ;  it  can  be  best 
compressed,  either  at  a  point  midway  between 


{1^^: 


Fig.  51.— Compression  of  the  Radial  and  Ulnar  Arteries. 

the  symphisis  pubis  and  the  iliac  spine,  pressure 
being  applied  directly  downward  (Fig.  52),  or 
lower  down  in  the  middle  of  the  thigh,  pressure 
being  applied  outward  after  the  knee  has  been 
first  flexed  and  the  thigh  rotated  outward. 
(Fig.  53.) 

N'ote. — In  compressing  the  femoral  arter}^,  the 
operator  should  stand  well  over  the  patient  and 
should  apply  the  pressure  with  both  thumbs  one 
upon  the  other. 

10.     The  Popliteal  Artery. — This  passes  along 


88 


FIEST  AW    TO    THE  INJURED 


the  middle  of  the  ham ;  it  can  be  best  compressed 
in  tlie  centre  of  the  middle  of  the  ham,  pressure 
being  applied  directly  forward. 

\ 


Fig.  52.— Compression  of  the  Conunon  Femoral  Artery 

11.  The  Posterior  Tibial  Artery. — This  passes 
below  the  internal  malleolus  ;  it  can  be  best  com- 
pressed at  a  point  a  thumb's  breadth  from  the 
internal  malleolus,  pressure  being  applied  for- 
ward and  outward. 

12.  The  Anterior  Tibial  Artery. — This  passes 


ILEMORRHA  GE  A  ND  HIS  IMMEDIA  TE  TBEA  TMENT    89 

along  the  middle  of  the  front  of  the  ankle ;  it  can 
be  best  compressed  at  a  point  midway  between 


Fig.  53.— Compression  of  the  Superficial  Femoral  Artery. 

the  two  malleoli,   pressure  being  applied  back- 
ward. 

Forced  Flexion. — In  bleeding  from  the  limbs 
digital  compression  of  the  artery  can  be  super- 
seded by  compression  of  the  artery  by  forced 
flexion  of  the  limb,  i.  e.,  by  bending  the  main 


00 


FJnST  AID    TO    THE  INJURED 


Temporal  artery 
Occipital  artery 


Facial  artery 
Commcn  carotid  artery 


Subclavian  artery 
-Arch  ot  the  aorta 

Axillary  artery 


Brachial  artery 
Abdominal  aortft 

Common  iliac  artery 
Common  femoral  artery 
Radial  artery 
Ulnar  artery 


1  Superficial 
arcb 


-     Superficial  femoral  artery 


Popliteal  artery 


.Anterior  tibial  artery 
Posterior  tibial  artery 


Fig.  54— Diagram  lo  show  the  course  of  the  Chief  Vessels. 

(The  arrows  indicate  the  points  where,  and  tlie  diiection  in  which 

pressure  can  be  applied  most  effectively.) 


1L1DI0URHA  GE  AND  ITS  IMMEDIA  TE  THE  A  TMENT    91 

artery  acutely  over  a   pad  placed  in  the  joint 
above  the  wound. 

The  joints  where  this  method  can  be  used  are : 
the  armpit  (Fig.  55),  the  bend  of  the  elbow  (Fig. 


Fig.  55.— Compression  of  the  Axillary  Artery  by  Forced  Flexion. 

56),  the  fold  of  the  groin  and  the  bend  of  the 
knee.     (Fig.  57.) 

Mode  of  Procedure. — Place  a  hard  pad,  not 
too  large,  in  the  joint  above  the  wound,  flex  the 


92  FIRST  AID    TO    THE  INJURED 

limb  over  the  pad,  and  tie  it  to  tiie  part  above  by 
means  of  a  triangular  bandage  folded  narrow. 


Fig,  56.— Compression  of  the  Brachial 
Artery  by  Forced  Flexion. 

Forced  flexion  is  uncomfortable,  and  if  the  pa- 
tient is  left  alone,  he  may  pull  the  bandage  to  re- 
lieve the  discomfort  and  displace  the  pad,  caus- 
ing the  bleeding  to  recommence,  therefore.  Con- 
striction of  the  whole  limb  above  the  bleeding 
point  is  better ;  this  can  be  effected  by  : 

(I)  A  Narrow-Fold  Triangular  Bandage  tied 
loosely  in  a  knot  round  the  limb,  and  then  twisted 
round  several  times  by  means  of  a  stick  inserted 
into  the  loop  to  make  it  tight,  or 

(II)  By  EsmarcNs  Elastic  Band  or  Ttibe^ 
which  are  applied  as  follows :  First,  a  turn  of  a 
wide   Roller   bandage   is  fixed  round  the  limb 


IJ.miORRHA  GE  A  ND  ITS  IM3TEDIA  TE  THE  A  TMENT    93 

where   the   band  (or  tube)  is  to  be  applied  iii 
order  to  protect  the  skin ;  the  band  (or  tube)  is 


Fig.  57.— Compression  of  the  Popliteal  Artery 
by  Forced  Flexion. 


then  well  stretched,  the  limb  encircled  with  it  at 
this  spot  two  or  three  times,  and  the  ends  are 
then  either  tied,  or  hooked  off. 

Caution. — In  applying  Esmarch's  Band  care 
must  be  taken  that  it  is  just  tight  enough  to  stop 
the  circulation  and  nothing  more. 

The  disadvantages  of  the  above  method  (con- 
striction of  the  whole  limb),  are:  That  complete 
arrest  of  the  blood  supply  to  the  parts  below  the 
constriction  favors  a  tendency  to  mortification  of 


04  FIJiST  AID    TO   THE  INJUIiEI) 

the  limb,  therefore,  in  preference  to  constriction, 
tourniquets  should  be  used. 


Fig.  58. 

Tourniquets  are  instruments  con^t<*ucted  on 
the  principle  of  a  strap  to  encircle  tbc  limb,  a  pad 
to  place  on  the  artery,  and  a  screw,  buckle  oi- 
other  means  to  tighten  the  strap.  The  advantnge 
of  a  tourniquet  is  that  effect!  i'-c  pressure  can  be 
applied  to  the  main  artery  ^vithout  undue  con- 
striction of  the  whole  limb. 

The  kinds  of  tourniquets  most  suitable  are : 
The  htijrrovised  Tourniquet  or  Garrot. — This 
is  made  by  folding  a  Triangular  bandage  or  nn 
ordinary  handkerchief  like  a  cravat,  and  placing 
some  hard  substance  (such  as  a  cork  out  of  a  wine 
bottle)  in  its  folds,  to  act  as  a  pad  ;  the  pad  is 


IT.EMORRHA  GE  A  ND  ITS  IMMEDIA  TE  TEE  A  TMENT    1,5 

[Jaced  on  the    vessel,  the  handkerchief  is    tied 
oosely  once  over  a  soft  pad,  placed  against  the 


Fig.  58a. 
Fig.  58a.— The  Improvised  Tourniquet  applied  to  the  Thigh. 

limb  on  the  opposite  side  to  the  knot,  a  stick  is 
placed  in  the  tie  and  the  bandage  knotted  over 
it,  the  stick  is  then  twisted  round  several  times 


Fig.  59.— Volker's  Stick  Tourniquet  Applied. 


90  FIRST  AID    TO    THE  INJURED 

till  the  vessel  is  compressed  (Fig.  58),  and  then 
after  first  placing  the  pad  under  it,  it  is  tied  to 
the  limb  by  means  of  another  triangular  band- 
age folded  narrow.    (P^ig.  58^.) 

Volker^s  Stick  Tourni<2uet. — This  can  be  ap- 
plied only  to  the  arm  ;  it  is  made  by  taking  two 
sticks  G  to  8  inches  long,  ^  inch  thick,  and 
notched  at  the  ends;  after  first  encircling  the 
limb  with  a  couple  of  turns  of  a  roller  bandage  at 
the  spot  where  the  vessel  is  to  be  compressed, 
one  stick  is  placed  on  the  artery,  and  the  other 


Fig.  60.— EsiiKuchs  Touniiqiiet 


on  the  opposite  side  to  it,  the  two  are  then  tied 

together  at  their  ends,  top  and  bottom.    (Fig.  59.) 

Esmarcli's  Tourniquet. — Figure  60  sufficiently 

explains  the  construction  of  this  ;   it  is  applied  in 


B.l^MO  mill  A  a  K  A  ND  ITS  IM3IEDIA  TE  THE  A  T3IENT    r<7 

the    same    manner    as    Esmarch's    band.     (Fig. 

61.) 

The  Field  Tourniquet. — This  has  the  disad- 
vantage that  it  can  never  be  drawn  tight  enough 
and  the  pad  is  therefore  liable  to  slip. 


Fig.  61.— Esmarch's  Tourniquet  Applied. 

The  Screw  Tourniquet. — This  tourniquet  is 
provided  with  a  screw,  by  means  of  which  it  can 
be  further  tightened  after  buckling,  and  it  is 
therefore  a  more  efficient  instrument. 

A  tourniquet  may  be  safely  kept  on  for  three 
hours,  but  if  the  bleeding  has  entirely  stopped 
it  is  better  to  loosen  the  tourniquet  slightly 
after  an  hour's  application,  taking  care  to  ngain 
tighten  it  up  should  the  haemorrhage  recur. 

The  Treatment  of  Constitutional  Symptoms. — 
In  order  to  counteract  syncope  or  fainting  due  to 


98  FIRST  AID    TO    THE  INJURED 

the  loss  of  blood,  the  patient  must  be  kept  at 
absolute  rest  in  a  recumbent  position  with  the 
feet  slightly  raised ;  his  clothes  should  be  re- 
moved, his  body  should  be  wrapped  in  warm 
blankets,  and  hot- water  bottles  should  be  applied 
to  his  feet.  If  able  to  swallow,  stimulants  well 
diluted  are  to  be  given  in  small  quantities,  but 
only  after  the  haemorrhage  has  entirely  stopped. 
If  the  loss  of  blood  has  been  very  excessive,  the 
breathing  may  become  embarrassed,  or  may 
actually  stop ;  artificial  i-espiration  after  the 
Sylvester  method  must  then  be  resorted  to. 


HJ^MOHRHA  GE  AND  ITS  13131  EDI  A  TE  THE  A  TMENT 


99 


I'ait  Wounded. 


1  riie  Temple, 
Mie  Front  or 
t.ie  Top  of  tlie 
Head 


The  Back  of 
tlie  Head 


3.  The  Face  be- 
low the  Eyes 

4.  The  Neck    - 


5.  Tlie  Shoulder 
or  the  Axilla 


The  Upper 
Tiilrd  of  the 
Arm 


7.  The  Lower 
T  w  o  - 1  li  i  r  ds 
of  the  Arm 


Artery 
to  Compress. 


The  Temporal 


The  Occipital 


The  Facial 


The      Conniion 
Carotid 


The  Subclavian 


The  Axillary 


The  Brachial 


Passes  over  the 
zygoma 


Passes  over  the 
mastoid  proc- 
ess 


Passes  over  the 
lower  jaw 

Pusses  along  tlie 
side  of  the 
neck,  from  a 
point  midway 
between  the 
angle  of  the 
jaw  and  tlie 
mastoid  proc- 
ess to  the 
sternal  end  of 
the  clavicle 


Passes  across 
the  upper  sur- 
face of  tlie 
first  rib 


Passes  over  the 
apex  and 
a  long  the 
outer  side  of 
tlie  axilla 

Passes  along  the 
inner  border 
of  the  biceps 
muscle,  in  a 
line  with  tiie 
inner  seam  of 
the  coat 


Point  where  Pressure  is 
to  be  applied. 

One  finger's   breadth  iv 
front   of   the    openin 
of  the  ear 


Two  fingers'  breadth 
from  tlie  centre  of 
the  back  of  the  ear 


One  inch  in  front  of 
the  angle  of  the  jaw 

One  and  a  half  inches 
above  the  sterno-cla- 
vicular  joint 


Behind    the    middle    of 
tlie  clavicle 


At  the  junction  of  the 
outer  with  the  middle 
third  of  the  armpit 


The  middle  of  the  arm 


loo 


FIRST  AID   TO   THE  INJURED 


Direction  of  tlie 
Pressure. 

Directly    against    the 
bone 


Ditto    - 


Ditto   -        -        -        - 

Inward  aiul  backward 
against  tlie  trans- 
verse process  of  tlie 
sixth  cervical  ver- 
tebra 

iVo^e.— This  vessel 
requires  considerable 
care  to  compress, 
pressure  on  the 
neighboring  struc- 
tures (nerve,  vein, 
trachea,  etc.),  must 
be  carefully  avoided. 

With  the  slioulder  and 
clavicle  depressed, 
downward  and  back- 
ward agaJTist  the 
upper  surface  of  the 
first  rib 

With  tlie  arm  raised, 
outward  and  back- 
ward against  the 
humerus 

Outward  and  back- 
ward against  the 
humerus 


Kind  of  Pressure  to  be 
employed. 


ligi 
nlai 


then  a 
pad  placed  on  the 
artery  and  retained 
in  position  by  means 
of  a  narrow-fold 
twisted  triangular 
bandage,  or  a  knot- 
ted roller  bandage 

First  digital, then  a  pad 
on  the  artery,  and 
retained  in  position 
by  a  narrow-fold 
triangular  bandage 

Ditto    -        -        -        . 

Digital 


Digital  first  and  then 
the  handle  of  a  door 
key  padded 


Digital  first  and  then 
forced  flexion 


Digital  first  and  then 
either  Volker's  stick 
tourniquet,  or  forced 
flexion,  i.  e.,  a  firm 
pad  in  axilla  and 
arm  bandaged  to 
side  of  chest,  or  by 
Esmarch's  band  or 
a  tourniquet  (impro- 
vised, screw,  or 
field) 


Subsequent  Treatment  after 
theHaemorrliage  has  stopped. 


Dress  the  wound,  placing  a 
linn  clean  pad  over  it 


Ditto 


Ditto 

When  the  bleeding  hascom- 
pletely  stopped,  dress  the 
wound,  bend  the  liead  for- 
ward u|)on  the  chest  and 
fix  it  in  tills  position  by 
means  of  bandages  and 
pillows 


Dress  the  wound,  apply  a 
sj^ica  bandage  to  the 
shouldei-  to  retain  the 
dressings  and  place  the 
forearm  in  a  large  arm 
sling 

Ditto 


Dress  the  wound  and  place 
the  forearm  in  a  large  arm 
sling 


H.EMOURHA  GE  A  ND  ITS  IMMEDIA  TE  TREA  T3IENT        101 


Part  Wounded. 

Artery 

Course  of  the 

Point  where  Pressure  is 

to  Compress. 

Artery. 

to  be  applied. 

8.  The  Forearm 

The  Brachial    - 

Under  the  inner 
edge    of   the 
tendon  of  the 
biceps  muscle 

At  the  bend  of  the  elbow 

9.  The  Palin  of 

Tlie  Kadial  and 

Along     the 

One  inch  above  the  wrist 

the  Hand 

the  Ulna 

outer  and  tiie 
inner  borders 
of  the    wrist 
respectively 

on  each  side 

10.  The      Upper 

The      Common 

Passes  over  the 

At  the  bend  of  the  groin 

Tlihd  of  the 

Femoral 

pubes 

midway    between    the 

Thigh 

symphysis  and  the  iliac 
spine 

11.  The     Lower 

The  Superficial 

Passes  along  a 

The  middle  of  the  thigh 

Two-thirds  of 

Femoral 

line       drawn 

the  Thigh 

from  the  mid- 
dle    of     the 
bend    of   the 
groin    to   the 
inner  side  of 
the  knee 

12.  The  Leg       - 

The  Popliteal  - 

Along  the  mid- 
dle    of      the 
ham 

In  the  centre  of  tlie  iiam 

13.  The  Foot     - 

The     Posterior 

Below   the    in- 

A thumb's  breadth  from 

Tibial 

ternal  malle- 
olus 

the  internal  malleolus 

The      Anterior 

Middle    of  the 

Midway  between  the  two 

Tibial 

front    of   the 
ankle 

malleoli 

102 


FlRtiT  AID   TO   THE  INJURED 


Direction  of  tlie 
Pressure. 


Downward  and  back- 
ward agaiust  the 
humerus 

Directly  backward 
against  the  radius 
and  tlie  ulna 


Di rect I y  d  o  w  n  w  a  r  d 
against  the  pubes 


With  the  knee  slightly 
flexed  and  the  thigh 
rotateci  o  u  t  w  a  r  d  , 
outward  against  tlie 
femur 


Directly  against  the 
posterior  surface  of 
the  lower  end  of  the 
femur 

Forward  and  outward 
against  the  tibia 

Backward  against  tlie 
tibia 


Kind  of  Pressure  to  be 
employed. 


Forced  flexion  at  the 
bend  of  the  elbow 


Digital 


Digital  with  both 
thumbs  one  upon 
the  other,  or  forced 
flexion  with  a  firm 
pad  on  the  artery 


Digital  first  with  both 
thuml)S  one  upon 
Iht^  otiier.  and  then 
Esmarcli's  band  or 
a  tourniquet 


Forced  flexion  at  the 
bend  of  the  knee 


A  pad  placed  on  each 
vessel  and  a  band- 
age tied  round  the 
ankle  to  retain  the 
pads  in  position 


Subsequent  Treatment  after 
the  Haemorrhage  has  stopped. 


Dress  the  wound  and  sling 
the  elbow 


Dress  the  wound,  place  a 
hard  pad  in  the  palm,  bend 
the  fingers  over  it  and 
bandage  them  to  the  hand, 
then  place  a  firm  pad  in 
the  bend  of  the  elbow, 
flex  the  forearm  upon  the 
arm  and  sling  the  elbow 
with  the  injured  hand  rest- 
ing against  the  oi)posite 
shoulder 

Dress  the  wound,  fix  the  pad 
on  the  artery  and  the 
dressings  on  the  wound 
with  a  spica  bandage  to 
the  groin,  then  apply  a 
long  splint  to  the  outer 
side  of  the  injured  limb, 
and  keep  tlie  patient  in  a 
recumbent  position  with 
the  foot  slightly  raised 

Dress  the  wound,  apply  a 
long  splint  to  the  outer 
side  of  the  injured  limb, 
and  keep  the  patient  in  a 
recumbent  position  with 
the  foot  slightly  raised 


Dress  the  wound  and  keep 
the  patient  in  a  recumbent 
position 

Dress  the  wound  and  keep 
the  foot  slightly  raised 


HJ^3I0RBHAGE  AND  ITS  IM3IED1A  TE  TEE  A  TMENT  103 

INTERNAL  HAEMORRHAGE 

The  Causes  of  internal  haemorrhage  are : — 

(I)  Injury  from  blows,  punctured  wounds, 
severe  crushes,  and  falls  from  a  height  causing 
bruising  and  laceration  of  internal  organs. 

(II)  Disease  producing  weakening  and  then 
bursting  of  a  blood-vessel. 

The  blood  in  internal  haemorrhage  may  either 
escape  into  one  of  the  closed  cavities  of  the  body, 
such  as  the  abdomen,  cranium,  or  thorax,  or  it 
may  make  its  escape  externally  through  an  open- 
ing in  the  body,  artificial  or  natural. 

Serious  haemorrhage  into  a  closed  cavity  is 
denoted  by  the  history  of  the  accident  and  the 
signs  of  syncope  or  fainting.  The  measures  to 
be  adopted  in  a  condition  of  this  description, 
are: — 

(I)  To  send  at  once  for  medical  assistance. 

(II)  In  the  meanwhile  to  treat  the  constitu- 
tional symptoms  which  are  due  to  the  loss  of 
blood. 

When  blood  makes  its  escape  through  one  of 
the  natural  openings  of  the  body,  it  may  take 
the  form  of  : — 

(i)  Blood  Spitting :  (2)  Blood  Vomiting  / 
{3)     Nose  Bleeding. 


104  FJIiST  AID    TO   THE  INJURED 

I.     Blood  Spitting. — This  may  proceed  from  : — 

(a)  The  Mucous  Membrane  of  the  Mouthy 
especially  tlie  gums,  or  from  the  cavity  left  after 
the  extraction  of  a  tooth. 

Treatment. — If  the  bleeding  is  slight,  the 
patient  must  wash  his  mouth  out  with  hot  water, 
as  liot  as  it  can  be  borne,  or  with  a  solution  of 
alum,  or  with  a  strong  solution  of  salt  and  water, 
or  small  pieces  of  ice  must  be  given  him  to  suck. 
If  the  bleeding  is  from  the  socket  of  a  tooth, 
plug  it  well  with  a  pledget  of  cotton  wool  which 
has  been  dipped  in  a  solution  of  salt  and  water. 
If  the  bleeding  is  severe,  apply  pressure  directly 
to  the  bleeding  point  if  possible,  by  means  of  a 
small  pad  of  clean  lint. 

(Z»)  The  Throaty  caused  by  injury  to  the  wind 
pipe  or  gullet. 

Treatment. — Keep  the  patient  quiet  in  a  re- 
clining position,  and  give  him  small  pieces  of  ice 
to  suck  at  frequent  intervals. 

(c)  The  Posterior  Surface  of  the  Mucous 
Memhrane  of  the  Nose. 

Treatment. — (See  Bleeding  from  the  Nose.) 

{d)  From  the  Lungs  {Ilmmojytysis). — Bleeding 
from  the  lungs  is  indicated  by  scarlet  and  frothy 
blood    being   coughed    up    in   mouthfuls.     It   is 


ILKMORRHAGE  AND  ITS  IMMEDIATE  TUEAIMENT  105 

usually  the  result  of  either  disease  of  the  lungs 
or  injury  to  the  ribs. 

Treatment.— (I)  Send  at  once  for  medical- 
assistance,  in  the  meanwhile  — 

(II)  Lay  the  patient  down  on  his  side  with 
his  head  and  shoulders  slightly  raised  on  a 
pillow ;  keep  him  absolutely  quiet,  and  prevent 
him  from  talking  or  making  the  slightest  ex- 
ertion. 

(III)  Open  the  windows  and  admit  plenty  of 
fresh,  cool  air  into  the  room. 

(lY)  Give  the  patient  ice  to  suck,  or  let  him 
sip  cold  water,  or  vinegar  and  cold  water,  or  a 
strong  solution  of  alum  and  water,  or  strong  cold 
tea  with  a  lump  of  ice  in  it. 

(V)  Remove  all  constrictions  round  the  pa- 
tient's chest,  and  apply  cold  to  it  either  by  means 
of  an  ice  bag,  or  a  cloth  which  has  been  rung 
out  in  ice-cold  water. 

(YI)  If  the  faintness  is  severe,  be  cautious  in 
the  administration  of  stimulants. 

(YII)  Apply  smelling  salts  to  the  nostrils, 
and  warmth  to  the  feet. 

2.  Blood  Vomiting  (Hsematemesis). — This  is 
usually  caused  by  disease  affecting  the  walls  of 
the  stomach. 


106  FlliiiT  Alb   TO    THE  INJURED 

Its  occurrence  is  preceded  by  faintness,  with  a 
feeling  of  weight  at  the  pit  of  the  stomach,  pale- 
ness of  the  face,  and  a  feeble  pulse.  The  blood 
vomited  up  is  dark  in  color,  sometimes  coagu- 
lated and  mixed  with  food,  and  presents  the  ap- 
pearance more  or  less  of  coffee  grounds. 

Treatment. — The  same  as  that  for  bleeding 
from  the  lungs. 

3.  Bleeding  from  the  Nose  (Epistaxis). — This 
may  be  due  to  injury  to  the  nose  ;  it  may  be  an 
effort  of  nature  to  relieve  a  diseased  condition, 
and  if  so  it  is  not  to  be  lightly  stopped  ;  or  it 
may  be  the  result  of  general  constitutional  dis- 
turbance. 

Treatment. — If  severe,  send  at  once  for  med- 
ical assistance  and  take  care  that  the  doctor  is 
made  acquainted  with  the  nature  of  the  case ;  in 
the  meanwhile  undo  all  tight  clothing  round  the 
neck,  make  the  patient  sit  down  on  a  chair  or 
sofa,  with  his  head  slightly  thrown  back  (never 
allow  the  patient  to  hang  his  head  over  a  basin), 
open  the  window,  raise  the  arms  stretched  to 
their  full  extent,  well  above  and  behind  the  head, 
and  keep  them  in  that  position,  apply  a  cold  wet 
sponge,  or  a  wet  towel,  or  a  lump  of  ice  to  the 
back  of  the  neck  between  the  shoulder  blades. 


HjEMOBRHAGE  and  its  immediate  TREAT3IENT  107 

also  apply  cold  to  the  root  of  the  nose  ;  if  the 
bleeding  does  not  stop,  syringe  out  the  nostril 
from  which  the  blood  is  flowing  with  cold  water, 
or  with  a  solution  of  alum  (1  to  2  teaspoonfuls  to 
a  pint  of  water),  or  with  cold  tea.  Pinch  the 
nose  just  below  the  bridge  between  the  thumb 
and  forefinger,  or  take  a  piece  of  soft  rag,  wrap 
it  up  tiglitly  and  pass  it  gently  into  the  bleeding 
nostril. 


CHAPTER  IV 

WOUNDS    AND   THEIR   IMMEDIATE   TREATMENT 

Wounds— Definition — Kinds  and  Varieties  of — The  Immediate 
Treatment  of  Wounds  in  General — The  First  Field  Dress- 
ing— The  Immediate  Treatment  of  Incised,  Contused, 
Punctured  and  Lacerated  Wounds — Poisoned  Wounds — 
The  True  Poisoned  Wound — The  Treatment — Insect  Stings 
— Snake  and  Dog  Bites,  and  their  Treatment. 

Definition. — Wounds  may  be  defined  as  in- 
juries to  the  body  with  division  of  the  skin  and 
of  the  underlying  parts,  more  or  less. 

Wounds  are  of  two  kinds : — I.  Simjjle  ;  II. 
Poisoned. 

I. — Simple  Wounds  present  the  following  va- 
rieties : — 

(«)  Incised  or  Clean  Cut  Wounds. — Wounds 
with  cleanly  divided  edges  and  more  or  less  free 
bleeding,  produced  by  sharp  edged  instruments. 

ih)  Contused  or  Bruised  Wounds. — Wounds 
with  bruising  of  the  parts  and  only  slight  or  no 
external  bleeding,  produced  by  blunt  instru- 
ments. 

108 


rroUNDS  AND  THEIli  IMMEDIATE  TREATMENT    109 

{c)  Ptmctured  or  Stah  WoiiQuls. — Wounds 
with,  as  a  rule,  considerable  bleeding  and  deep 
internal  injuries,  produced  by  sharp  pointed  in- 
struments. 

{d)  Lacerated  Wounds. — Wounds  with  ragged 
edges  and  very  little  bleeding,  caused  by  tears, 
as  from  machinery  in  motion,  the  bites  of  ani- 
mals, etc. 

Bullet  wounds  generally  combine  the  charac- 
ters of  punctured  and  lacerated  wounds,  with,  in 
some  cases,  injury  to  the  bone. 

The  Immediate  Treatment  of  Wounds  in 
General 

Here  the  following  points  are  to  be  borne  in 
mind  : — 

(I)     To  arrest  the  bleeding. 

(U)     To  cleanse  the  wound. 

(Ill)  To  keep  the  wounded  parts,  if  possible, 
at  rest  by  the  application  of  slings  or  splints. 

(lY)  To  protect  the  wound  from  outside 
dust  and  dirt  by  means  of  some  antiseptic  (clean) 
dressing  material. 

(V)  To  treat  constitutional  symptoms,  if  any, 
such  as  shock  or  syncope. 

Therefore,  when  a  wound   has  been  inflicted, 


no  FIRST  AID    TO   THE  INJURED 

the  first  thing  to  do  is  to  avoid  touching  it  with 
dirty  hands  or  dirty  instruments  ;  there  is  no 
justification  for  introducing  more  dirt  into  a 
wound  that  may  be  already  dirty. 

After  arresting  the  bleeding  proceed  as  fol* 
lows  : — 

If  no  means  are  readily  available  to  render  the 
hands  and  the  wound  clean,  either  leave  the 
wound  alone  or  cover  it  up  with  some  antiseptic 
dressing,  if  one  can  be  got  at  once,  till  means  are 
at  hand  to  cleanse  the  wound. 

As  an  emergency  dressing  nothing  can  be  bet- 
ter than  the  First  Field   Dressing  used  in  the 
British  Army.     This  consists  of  — 
An  outer  cover  (sewn  cloth) 
Two  safety  pins 
An  inside  cover  (thin  waterproof,  cemented 

air-tight) 
Thin   waterproof  (mackintosh)  folded  over 
dressings  (size  12  in.  by  6  in.,  to  be  torn  in 
half  if  required) 
Gauze  bandage  4^^   yards  long,  folded  flat 

into  2^  in.  by  4  in. 
Piece  of  gauze  17  in.  by  13  in.,  weighing  not 
less   than   three  pennyweights,  folded  to 
suit  the  size  of  the  package 


WOUiXDS  AND  THE  HI  IMMEDIATE  TREAT3TENT    111 

Compress  of  cuiu[)ressed  charpie  (lint)  to  be 
of  fiax  between  layers  of  gauze  (like  Gam- 
gee's   dressing),  capable  of   being   teased 
out  into  a  thick  pad.     Minimum  weight 
of  charpie  155  grains.     Maximum  weight 
165  grains 
The  antiseptic  agent  used  is  corrosive  subli- 
mate 1  in  1000. 
To   Cleanse  the  W^ound    do   not   attempt   to 
wash  it  with  water  procured  from  any  source. 
Before    handling   the    wound    with   the   fingers 
wash  the  hands  first  with  warm  water  and  soap, 
and  tlien  rub  them  with  turpentine  or  rinse  them 
in  carbolic  solution  1  in  40,  then  wash  the  wound 
thoroughly  with  an  antiseptic  solution,  such  as 
carbolic  acid  1  in  20  to  1  in  40,  or  perchloride  of 
mercury  1  in  1000  to  1  in  2000. 

If  the  above  solutions  are  not  at  hand  or  can- 
not be  easily  procured,  any  of  the  following  may 
be  used : — 

Alcohol,  in  the  form  of  whiskey  or  methylated 
spirits,  with  an  equal  bulk  of  water  which  has 
been  first  well  boiled  and  then  allowed  to 
cool. 

Condifs  Fluid,  two  tablespoonfuls  to  a  pint 
of  warm  water. 


11-2  FIRST  AID    TO    THE  INJURED 

Coiiimon  Salt,  a  dessert-spoonful  dissolved  in  a 
tumbler  of  warm  water. 

In  washing  the  wound  be  careful  not  to  de- 
tach any  blood  clots  which  may  have  formed  in 
it,  as  they  prevent  further  bleeding  and  exclude 
impurities. 

After  the  wound  has  been  well  cleansed  of  all 
dirt,  in  order  to  keep  it  clean  take  a  pledget  of 
cotton  wool,  soak  it  well  in  the  antiseptic  solu- 
tion which  has  been  used  to  wash  the  wound, 
squeeze  it  dry  and  place  it  over  the  wound  as  a 
temporary  protection. 

To  Dress  the  Wound  proceed  as  follows  : — If 
ready-made  antiseptic  surgical  dressings  are  at 
hand  use  them,  if  not,  place  on  the  wound 
either  — 

A  piece  of  clean  linen  which  has  been  well 
boiled  for  five  minutes  and  then  wrung  out,  or  a 
piece  of  lint  soaked  in  carbolic  solution  1  in  40, 
carbolic  oil  1  in  10. 

Over  this  apply  a  few  layers  of  clean  cotton 
wool,  and  then  a  bandage  to  keep  the  dressing  in 
position. 

To  keep  the  parts  at  Rest.— First  place  the 
edges  as  near  together  as  possible  by  strai)pi ng, 
and  then,  should  the  wound  be  in  the  upper  ex- 


wo  UNDS  A  ND  THEIR  IM3fEDTA  TE  TEE  A  TMENT    1 1 ". 

treniity,  put  the  forearm  in  a  large  arm  sling  ;  it' 
the  wound  happens  to  be  near  a  joint,  appiv"  a 
splint  and  then  put  on  the  sling ;  if  the  lower 
extremity  is  wounded  apply  an  outside  splint  to 
the  limb.  Should  the  wound  be  in  the  abdomen 
or  chest,  bandage  firmly. 

To  treat  syncope  or  shock — {see  Chapter  YIII, 
page  193). 

Special  Points  in  the  Immediate  Treat- 
ment OF  — 
I.  Incised  Wounds. — Arrest  the  bleeding : 
then,  if  necessary,  wash  and  dress  the  wound  as 
indicated  abov^e  ;  if  the  edges  of  the  wound  gape, 
adjust  them  by  means  of  strapping,  taking  care 
not  to  completely  cover  the  wound ;  the  strap- 
ping is  best  applied  thus — two  strips  of  strapping 
long  enough  to  reach  well  beyond  the  edges  of 
the  wound  are  taken ;  in  the  centre  of  one  piece 
a  longitudinal  slit  is  cut ;  the  edges  out  of  the 
centre  of  the  other  piece  are  cut  away,  so  that 
this  piece  can  fit  into  the  longitudinal  slit ;  one 
piece  is  now  placed  on  one  side  of  the  wound, 
the  other  piece  on  the  other  side,  the  middle 
parts  are  slipped  one  into  the  other  and  an  even 
pull  is  made  simultaneously  on  both  {see  Fig.  62). 


114  FIRST  AID   TO   THE  INJURED 


Fig.  62.— Method  of  Applying  Strapping. 

2.  Contused  Wounds.— Apply  pressure  to  the 
part  by  means  of  a  pad  of  cotton  wool  or  linen 
dipped  in  one  of  the  antiseptic  solutions  enumer- 
ated above  if  the  skin  is  broken,  and  fix  the  pad 
by  a  narrow  folded  triangular  bandage,  or  a 
figure  of  8  roller  bandage ;  should  the  skin  not 
be  broken,  apply  to  the  part  a  piece  of  lint  which 
has  been  soaked  in  a  lotion  consisting  of  spirits 
of  wine  one-third,  and  water  two-thirds;  and 
moisten  it  often. 

3.  Punctured  Wounds. — Arrest  the  bleeding 
and  wash  and  dress  the  wound. 

4.  Lacerated  Wounds. — Wash  and  dress  the 
wound.  Shock  usually  supervenes  after  severe 
lacerations,  therefore  if  present,  treat  it. 

II.     Poisoned  Wounds. 
These  may  be  — 


HOUNDS  A  AD  THEIR  IMMEDIATE  TREATMENT    115 

(c()  The  True  Poisoned  Wound. — Produced 
by  the  introduction  of  decomposing  animal  mat- 
ter or  other  dirt  under  the  skin. 

Treatment. — Wash  the  part  immediately 
with  a  strong  disinfectant. 

{h)     /Stings  of  Insects. 

Treatment. — Extract  the  sting  by  pressing  a 
small  key  (a  watch  key  is  the  best)  on  to  the 
wounded  part,  wash  the  wound  with  a  solution  of 
ammonia,  soda  or  potash,  or  with  an  antiseptic 
solution. 

A  certain  amount  of  shock  may  sometimes 
supervene;  if  so,  give  stimulants. 

(<?)     Snake  Bites. 

Treatment. — Send  for  medical  assistance,  but 
in  the  meanwhile  apply  a  ligature  or  an  im- 
provised tourniquet  on  the  limb  between  the 
wound  and  the  heart,  to  prevent  the  general 
absorption  of  the  poison  into  the  system  ;  bathe 
the  wounded  part  first  with  warm  water  to 
encourage  bleeding,  then  with  strong  antiseptic 
solutions,  then  cauterize  the  wound  with  a  red 
hot  iron,  or  nitrate  of  silver.  To  extract  the 
poison,  sucking  the  wound  may  be  resorted  to, 
but  the  operator  should  see  that  he  has  no  cuts 
or  fissures  about  his  lips  or  tongue.     Treat  shock 


116  FIRST  AID   TO   THE  INJURED 

if  present  by  administering  stimulants  freel)^, 
and  artificial  respiration  may  have  to  be  re- 
sorted to. 

(d)     Bites  hy  Mad  Dogs. — Adopt  treatment 
the  same  as  that  for  snake  bites. 


CHAPTEK  y 

SPRAINS,  DISLOCATIONS,  FKACTURES,  AND  THEIR 
IMMEDIATE  TREATMENT 

Spraius:  DefinitioD,  Causes,  Signs,  and  Treatment  of — Dis- 
locations :  Definition,  Causes,  Signs,  and  Treatment  of — 
Fractures:  Definition,  Causes,  Kinds,  Varieties,  Repair, 
Signs,  and  Treatment  of — Splints,  improvised  and  their 
application — The  Transport  of  Patients  suffering  from 
Fractures — The  Immediate  Treatment  of  a  Compound 
Fracture — Special  Fractures— Their  Causes,  Signs,  and 
Treatment,  viz.,  of  the  Skull:  Vault,  Base  and  Jaw;  of 
the  Trunk  :  Spine,  Ribs,  and  Pelvis  ;  of  the  Upper  Ex- 
tremity :  Collar  Bone,  Arm,  Elbow,  Forearm,  Wrist, 
Hand  or  Fingers  ;  of  the  Lower  Extremity  :  Thigh,  Knee- 
cap, Leg,  Foot. 

SPRAINS 

Definition. — A  sprain  is  the  straining  or  tearing 
of  the  ligaments  and  capsule  which  surround  a 
joint,  by  a  sudden  twist  or  wrench — a  sprain  is 
practically  a  "  missed  dislocation." 

Causes : — Falls  on  to,  or  some  sudden  and  un- 
natural movement  of,  a  joint. 

Signs : — Pain,  heat,  and  swelling  at  the  seat  of 

117 


118  FIRST  AID   TO   THE  INJURED 

the  injury,  followed  subsequently  by  discoloration 
of  the  skin. 

Treatment. — Put  the  parts  at  complete  rest ; 
if  the  sprain  is  in  a  joint  of  the  upper  extremity, 
apply  a  padded  splint  to  the  inside  of  the  limb, 
and  then  place  the  forearm  in  a  large  arm  sling ; 
if  in  a  joint  of  the  lower  extremity,  place  the 
patient  in  bed,  apply  a  padded  back  splint  to  the 
limb  and  keep  it  slightly  elevated.  After  the 
limb  has  been  put  at  rest,  apply  bandages  dipped 
in  cold  water,  or  an  ice  bag,  to  the  injured  joint ; 
if  the  pain  is  severe  and  cold  applications  cannot 
be  tolerated,  bathe  the  joint  with  water  as  hot  as 
can  be  borne  comfortably,  or  apply  hot  bran 
poultices  to  it. 

DISLOCATIONS 

Definition. — A  dislocation  is  the  displacement 
of  a  bone  at  a  joint.     (Fig.  63.) 

Causes : — The  same  as  those  of  a  sprain,  but 
applied  more  violently. 

Signs: — {a)     Distortion  of  joint. 

{h)     The   end   of   the  displaced  bone 

may  be  felt  through  the  skin. 
{g)     Alteration  in  the  length  of  the 
limb. 


SFEA INS,  DISLOCA  TIONS,  FBA CTUBES 


119 


{d)     Loss  of  movement  at  the  joint. 

{e)  Pain  in  the  joint  increased  on 
movement. 

{/)  The  limb  is  tixed  when  another 
tries  to  move  it  (thus  distin- 
guishing it  from  fracture  near 
a  joint). 


Fig.  63.— Diagram  to  show  dislo- 
cation of  right  shoulder. 


Treatment. — Make  no  attempt  to  reduce  the 
dislocation ;  put  the  parts  at  complete  rest  to 
relieve  pain,  place  the  patient  in  an  easy  position 
and  send  for  medical  assistance. 


120 


FIRST  AID   TO   THE  INJURED 


FRACTURES 

Definition : — A  fracture  is  a  broken  bone. 
Causes : — 

1.  Direct  Violence^  by  means  of  which  the 
bone  is  broken  at  the  seat  of  the  injury. 

2.  Indirect  Violence,  by  means  of  which  the 
bone  is  broken  at  some  distance  from  the  seat  of 
the  injury  by  transmission  of  the  force  applied, 
e.  g.,  fracture  of  the  collar  bone  by  a  fall  upon 
the  outstretched  hand ;  fracture  of  the  base 
of  the  skull  by  a  fall  from  a  height  upon  the 
feet. 

3.  Mttscidar  action — snapping  the  bone  across 

by  a  sudden  and  violent 
contraction,  e.  g.,  the  knee- 
cap in  jumping. 

Varieties  of  Fractures. 
These  are : — 

I. — Simjple. — Where  the 
bone  only  is  broken. 

II.—  Compou7id.-V^\iQYQ 
the  bone  is  broken  and 
there  is  an  external  wound 
communicating  with  the 
break.     (Fig.  64.) 

JF'ig'.  64.— Compound  Fracture  v      o  / 

of  the  Tibia.  Jh  ractures  mav  be  :— - 


SPRAINS,  DISLOCATIONS,  FRACTURES 


121 


(I)  Com.ndnuted. — Where   the   bone  is  splin- 
tered into  several  fragments.     (Fig.  65.) 

(II)  Complicated. — Where     the    fracture    is 


Fig.  65.— Comminuted  Fracture  of  the  upper  end  of 
Kiglit  Fenuir. 

complicated  by  an  injury  to  some  important 
surrounding  parts,  e.  g.,  the  tearing  of  an  artery, 
vein  or  nerve;  the  opening  up  of  a  joint;  the 
wounding  of  an  internal  organ,  as  the  lung, 
bladder,  etc. 

(Ill)     Impacted. — Where  the  bones  are  broken 
and  the  ends  are  wedged  into  one  another.     (Fig. 


Fig.  66— Impacted  Fracture  of  the  lower  end  of 
Right  Femur. 

(lY)  Gi'eenstick. — Where  the  bone  is  incom- 
pletely broken  or  bent — usually  met  with  in 
children.     (Fig.  67.) 


122 


FIRST  AID    TO   THE  INJURED 


Repair  of  Fractures. — Fractures  are  repaired 
by  the  space  between  the  broken  ends  of  the 
bone  and  the  torn  periosteum  being  filled  up  by 
a    soft    mass  of    new  material — termed   callus, 


Fig.  67.— Gieenstick  Fracture  of  the  Radius. 

which  unites  the  broken  ends  together ;  in  course 
of  time  this  soft  material  is  converted  into  fibrous 
tissue,  then  lime  salts  are  deposited  in  it  and  it  is 
gradually  formed  into  bone ;  the  new  bone  can  at 
first  be  felt  as  a  thickened  mass  round  the  frac- 
ture (Fig.  68),  but  gradually  it  becomes  entirely 


Fig.  68.— Fracture  of  Femur  showing  deposit  of 
Callus  around  broken  ends. 


absorbed.  Should  the  broken  ends  of  a  bone  not 
be  kept  at  complete  rest  bony  union  never  results, 
the  callus  remains  fibrous  and  there  is  produced 
what  is  termed  a  false  joint. 


SriiAINS,  DISLOCATIONS,  FRACTURES  123 

Signs  of  Fracture. — These  are : — 

{a)  Pain,  swelling,  and  deformity  at  the  seat 
of  the  injury. 

{h)  Unnatural  mobility  where  none  should 
exist. 

( 6' )     Loss  of  power  in  the  limb. 

{d)     Shortening  of  the  limb. 

{e)  Crepitus,  i.e.^  a  sensation  of  grating  felt 
when  the  broken  ends  of  the  bones  are  made  to 
move  against  each  other. 

Treatment. — In  the  immediate  treatment  of 
a  fracture  the  following  points  have  to  be  borne  in 
mind  : — The  prevention  of  further  injury.  The 
proper  transport  of  the  injured  person. 

The  Prevention  of  Further  Injury.— For  this 
adopt  the  following  measures,  viz. : — 

1.  Attend  to  the  patient  on  the  spot  where 
the  injury  has  occurred,  and  especially  so  if  the 
fracture  happens  to  be  in  the  lower  extremity. 

2.  Don't  touch  the  limb  (beyond  what  is  ab- 
solutely necessary  for  diagnosis),  until  you  have 
all  splints  and  bandages  ready. 

3.  Use  extreme  care  and  gentleness  in  hand- 
ling the  limb,  either  for  the  purpose  of  trying  to 
make  out  the  fracture  (^.  e.,  trying  for  crepitus, 
etc.),  or  in  putting  on  splints  :  by  rough  handling 


124  FIRST  All)    TO    THE  INJURED 

a  simple  fractui-e  may  very  easily  be  made  into  a 
compound  or  complicated  one.  This  precaution 
is  to  be  especially  borne  in  mind  in  handling 
broken  bones  which  are  immediately  under  the 
skin,  such  as  the  collar  bone  (clavicle),  and  the 
shin  bone  (tibia). 

4.  Without  removing  the  clothes  (unless  the 
fracture  is  compound  or  there  is  hsemorrhage), 
bring  the  bones  into  their  relative  position  as  fol- 
lows: First  lift  the  limb  by  grasping  it  very 
gently  but  firmly  above  and  below  the  seat  of 
the  fracture,  and  then  make  gentle  extension  and 
counter-extension  to  restore  to  its  natural  posi- 
tion as  far  as  possible. 

5.  Fix  the  limb  in  this  position  by  means  of 
splints  and  bandages. 

SPLINTS 

These  are  rigid  supports,  which  are  applied  to 
parts  to  increase  either  their  natural  stiffness  or 
to  prevent  their  undue  mobility.  For  the  sur- 
geon's use,  splints  are  constructed  out  of  various 
materials  and  are  shaped  to  fit  the  limbs. 

For  the  "First  Aid"  treatment  of  fractures, 
splints  can  be  made  out  of  many  articles  in  daily 


SPliAINS,   DISLOCATIONS,  FRACTURES  125 

use,  etc.,  var^nng  according  to  the  patient's  sur- 
roundings at  tiie  time  of  the  accident,  e.  g.^  in 
domestic  life — broom  handles,  newspa}3ers,  wine 
bottle  covers,  stockings  filled  with  straw  or  sand, 
umbrellas,  walking  sticks,  etc. ;  in  workshops — 
pieces  of  wood,  laths,  rules,  squares,  etc.  With 
military  surroundings — a  rifle  for  fracture  of  the 
thigh,  a  sword  or  sword-bayonet  for  fracture  of 
the  leg,  a  bayonet  for  fracture  of  the  arm  or 
forearm. 

Imjjroved  Splints  should  be  always  con- 
structed out  of  material  which  is  sufficiently  stiff 
to  keep  the  parts  in  position ;  they  should  be 
made  long  enough  to  extend  some  distance  be- 
yond the  joint  below  the  fractured  bone,  and 
they  should  be  as  wide  as  the  limb  to  which  they 
are  to  be  applied.  Before  applying  splints  pad 
them  well  on  the  side  next  the  limb  (unless  the 
clothing  is  allowed  to  remain),  with  some  soft 
material,  such  as  tow,  cotton  wool,  old  flannel, 
folded  triangular  bandages,  etc.,  and  make  the 
padding  extend  well  over  on  each  side  of  the 
splint. 

To  apply  Splints  two  persons  are  required,  one 
keeps  up  gentle  extension  and  counter-extension 
in  the  manner  indicated  above,  while  the  other 


126  FIRST  AID   TO   THE  INJURED 

person  applies  the  splints,  one  on  each  side  of  the 
limb,  and  fixes  them  in  position  by  tying  them 
above  and  below  the  seat  of  fracture,  with  tri- 
angular bandages  folded  narrow,  or  with  straps, 
belts,  or  tapes.  In  fixing  splints,  all  knots  should 
be  tied  over  the  outer  splint  and  not  over  the 
bone.  The  methods  of  fixing  splints  to  limbs 
with  the  triangular  bandage  are  given  in  Chapter 
II,  pages  38  and  39. 

Improvised  splints  should  always  be  put  on 
in  such  a  wa}^  as  to  be  easily  removed  if  re- 
quired. 

The  Proper  Transport  of  the  Injured  Person. — 
It  is  important  to  bear  in  mind  that  a  person 
suffering  from  a  fracture  is  not  to  be  removed  till 
the  broken  bone  has  been  first  put  up.  If  able 
to  walk,  he  should  not  be  permitted  to  leave  the 
spot  unassisted,  as  faintness,  giddiness,  or  even 
unconsciousness  may  come  on  some  time  after  the 
fracture  has  occurred ;  most  persons  suffering 
from  fractures  of  the  upper  limb  can  walk  if  as- 
sisted. Those  suffering  from  fractures  of  the 
lower  limb  should  always  be  carried  on  a 
stretcher,  and  this  should  be  done  with  the  ut- 
most care,  so  as  to  avoid  further  inquiry. 


spiiaji\;s,  ijj^locations,  fractures        127 

The  Immediate  Treatment  of  a  Compound 
Fracture 

Here  proceed  as  follows  : — 

Remove  the  clothing,  if  required,  from  the  in- 
jured part,  with  extreme  care.  If  there  is 
hasmorrhage,  arrest  it  either  by  elevating  the 
limb,  or  applying  pressure  to  the  main  artery, 
above  the  wound.  If  transport  is  readily  avail- 
able, and  skilled  help  can  be  quickly  obtained, 
cover  the  wound  temporarily  with  an  antiseptic 
(clean)  pad  to  prevent  the  entrance  of  impurities, 
apply  splints  as  far  as  practicable  in  the  manner 
indicated  above  and  remove  the  patient  from  the 
scene  of  the  accident.  If  skilled  help  cannot  be 
speedily  procured,  thoroughly  cleanse  the  wound 
with  an  antiseptic  solution,  adopting  all  the  [)re- 
cautions  laid  down  in  Chapter  lY ;  apply  an 
antiseptic  dressing  to  the  wound,  then  put  on  the 
splints  and  remove  the  patient. 

SPECIAL  FRACTURES 

1. — Fractures  of  the  Skull 

I.    Fracture  of  the  Vault  of  the  Skull  (Cranium). 
Causes. — Usually  direct  violence,  as  blows,  or 


128  FJJiST  AID    TO    THE  INJURED 

falls  upon  the  head.  This  fracture  is  very  often 
compound. 

Signs. — The  broken  bone  may  be  felt,  or  there 
may  be  a  depression  in  the  skull  at  the  seat  of  the 
injury,  with  symptoms  of  concussion,  or  of  com- 
pression of  the  brain  ;  there  may  also  be  partial 
or  complete  loss  of  consciousness. 

Tk?]atment. — (I)  Send  at  once  for  medical 
assistance.     In  the  meanwhile  — 

(II)  If  there  is  a  scalp  wound  apply  a  pad  and 
triangular  bandage  as  laid  down  in  Chapter  II. 

(III)  Should  there  be  haemorrhage  arrest  it. 

(IV)  If  the  patient  has  to  be  removed,  place 
him  on  a  stretcher  with  the  head  raised  on  a 
higher  level  than  the  rest  of  the  body,  and  with 
great  care  carry  him  in  this  position. 

(Y)  Place  him  in  bed  in  the  above  position  in 
a  darkened  room,  and  keep  him  absolutely  quiet. 

(VI)  Apply  hot  water  bottles  to  the  feet,  and 
towels  wrung  out  frequently  in  cold  water  to  the 
head,  or,  what  is  better,  apply  an  ice  bag  to  the 
head. 

(VII)  Do  not  give  any  alcoholic  stimulants. 
2.     Fracture  of  the  Base  of  the  Skull. 
Causes. — Usually   indirect    violence,    as    falls 

from  a  height  upon  the  feet  or  the  head. 


SPIiAINS,  DISLOCATIONS,  FRACTURES  129 

Slyus. — Unconsciousness,  accompanied  usually 
with  bleeding  from  the  mouth,  ears,  or  nose. 

Treatment. — The  same  as  that  for  fracture 
of  the  Vault. 

3.     Fracture  of  the  Jaw. 

Causes. — Direct  violence.  This  fracture  is 
often  compound. 

Signs. — Deformity ;  unevenness  in  the  line  of 
the  teeth  ;  inability  to  close  the  mouth  ;  bleeding 
from  the  mouth  and  gums,  and  crepitus. 

Treatment. — (I)  With  the  hand  gently  push 
the  broken  ends  of  the  bone  into  their  natural 
position. 

(II)  Retain  the  ends  in  this  position  by  apply- 
ing either  the  triangular  (see  below),  or  the  four- 
tailed  bandage. 

(III)  If  the  bleeding  is  troublesome,  make 
the  patient  rinse  his  mouth  out  frequently  with 
cold  water,  or  giv^e  him  small  pieces  of  ice  to 
suck. 

(lY)  Caution  the  patient  not  to  attempt  to 
talk. 

For  applying  a  triangular  bandage  to  a  frac- 
tured jaw,  there  are  two  methods  : — 

{a)  Apply  the  centre  of  the  bandage  folded 
narrow  to  the  point  of  the  chin,  carry  the  ends 


130  FIRST  AID    TO    THE  INJURED 

upwards  on  each  side,  pass  one  end  over  the  top 
of  the  head  till  it  meets  the  other  end  just  above 
the  ear;  now  cross  the  two  ends  over  each  other, 


Fig.  69.— Triangular  Bandage 
lor  Fracture  of  Lower  Jaw. 


then  carry  one  end  in  front  of  the  forehead,  and 
the  other  behind  the  back  of  the  head  well  below 
the  occiput,  and  tie  off  on  the  side  of  the  temple 
just  above  the  ear.     (Fig.  69.) 

{!))  Take  one  bandage  folded  narrow,  place 
the  middle  of  it  over  the  point  of  the  chin,  carry 
the  two  ends  upward  and  tie  them  in  a  half 
knot  just  behind  the  vertex  of  the  skull,  then 
take  a  second  bandage  folded  narrow,  place  the 
centre  of  it  under  the  lower  lip,  pass  the  ends 


SPRAINS,  DISLOCATIONS,  FRACTURES  131 

backward,  tie  them  in  a  half  knot  at  the  level 
of  the  occiput  behind.  Now  tie  the  two  ends 
of  the  two  bandages  respectively  to  each 
other. 

The  application  of  the  four-tailed  bandage  is 
given  in  Chapter  II,  page  71 : — 

II. — Fractures  of  the  Trunk 
.   I.     Fracture  of  the  Spine. 

Causes. — Either  direct  or  indirect  violence. 

Signs. — The  body  is  paralyzed  below  the  seat 
of  the  injury,  i.  e.,  if  the  injury  has  been  inflicted 
just  below  the  neck,  the  patient  is  unable  to 
move  all  four  limbs  ;  if  the  seat  of  the  injury  is 
in  the  middle  of  the  back,  the  patient  is  unable 
to  move  his  legs.  There  is  usually  great  shock, 
and  on  running  the  tips  of  the  fingers  gently 
along  the  back  of  the  spine,  an  inequality  in  the 
spinal  ridge  may  be  felt. 

Caution. — Under  no  circumstances  attempt  to 
try  for  crepitus,  and  use  the  utmost  care  and 
gentleness  in  handling  the  patient. 

Treatment. — (I)  Send  at  once  for  medical 
assistance. 

(II)     If  possible,  do  not  attempt  to  remove  the 


135  FIRST  AID   TO   THE  INJURED 

patient  till  skilled  assistance  has  been  first  pro- 
cured, but,  in  the  meanwhile  — 

(III)  Treat  the  condition  of  shock,  i.  e.^  give 
stimulants  in  small  quantities  and  apply  hot  water 
bottles  to  the  feet. 

(IV)  If  the  patient  has  to  be  removed,  pro- 
ceed as  follows : — 

Obtain  a  door  or  shutter,  not  a  canvas  stretcher, 
and  with  the  least  possible  alteration  of  his  posi- 
tion, lift  the  patient  very  carefully  on  to  this, 
place  him  on  his  back,  and  carry  him,  avoiding 
all  jolting. 

(Y)  Place  the  patient  on  a  fracture  bed  {see 
Chapter  X),  making  him  lie  as  flat  as  possible 
with  only  a  very  low  pillow  for  the  head. 

2.     Fracture  of  the  Ribs. 

Causes. — Either  direct  or  indirect  violence,  or 
muscular  action.  This  fracture  may  be  com- 
plicated with  injury  to  the  lung. 

Signs. — Severe  pain  at  the  side,  generally  de- 
scribed as  a  stitch,  increased  on  taking  a  deep  in- 
spiration ;  short  and  hurried  breathing.  Crepitus 
may  be  felt  by  placing  the  palm  of  the  hand  on 
the  injured  side,  and  asking  the  patient  to  take  a 
deep  breath.  If  the  lung  is  injured  there  may  be 
spitting  of  blood. 


SPIiAINS,  DISLOCATIONS,  FRACTURES  133 

Treatment. — If  there  is  no  injury  to  the  lung, 
proceed  as  follows  : — 

(I)  Take  two  triangular  bandages  folded 
broad,  apply  the  centre  of  one  bandage  over  the 
seat  of  the  fracture,  carry  the  ends  round  the 
chest  and  tie  off  on  the  opposite  side.  Now  take 
the  second  bandage,  apply  the  centre  of  it  just 
above  the  seat  of  the  fracture,  making  it  overlap 
the  first  bandage,  carry  the  ends  round  the  chest 
and  tie  off  on  the  opposite  side.  In  tying  the 
bandages  tighten  them  till  the  patient  just  feels 
comfortable. 

Wote. — These  bandages  should  be  applied  dur- 
ing expiration.  Instead  of  triangular  bandages 
the  roller  bandage  may  be  applied  round  the 
chest  in  the  manner  indicated  in  Chapter  II, 
page  65. 

If  there  is  injury  to  the  lungs  or  severe  crush- 
ing of  the  walls  of  the  thorax,  apply  a  broad  flan- 
nel roller  bandage  to  the  chest  walls,  simply  to 
give  them  very  gentle  support.  Avoid  tight 
bandaging  of  any  description. 

(II)  Place  the  patient  in  bed  with  his  head  and 
chest  well  elevated. 

(III)  If  there  is  bleeding  from  the  lungs,  treat 
it  in  the  manner  indicated  in  Chapter  III,  page 


134  FIRST  AID    TO    THE  INJURED 

104,  and  carry  the  patient  placed  on  a  stretcher, 
the  head  and  chest  being  kept  carefully  ele- 
vated. 

3.     Fracture  of  the  Pelvis. 

Causes. — Direct  violence.  This  fracture  is  very 
often  complicated  with  injury  to  the  bladder  and 
other  internal  organs. 

Signs. — Severe  pain  in  the  pelvis  with  inability 
to  stand  ;  there  are  symptoms  of  shock  more  or 
less,  and  blood  may  be  passed  with  the  urine  if 
the  bladder  is  injured. 

TiiEATMENT. — (I)  Send  at  once  for  medical 
assistance.  In  the  meanwhile,  before  attempting 
to  remove  the  patient  — 

(II)  First  apply  firmly  round  the  pelvis  two 
triangular  bandages  folded  broad,  one  on  top  of 
the  other,  or  a  broad  flannel  roller  bandage,  then 
apply  two  long  splints,  reaching  from  the  arm- 
pits to  a  little  beyond  the  feet,  one  on  each  side 
of  the  body,  and  tie  them  in  position  by  means 
of  narrow-fold  triangular  bandages. 

(III)  Lift  the  patient  on  a  stretcher  and  re- 
move him  very  carefully. 

(IV)  Place  the  patient  on  a  fracture  bed  {see 
Chapter  X). 

(V)  Treat  the  condition  of  shock. 


Sri:.\L\S,   DISLOCATIONS,  FRACTURES 


135 


Instead  of  the  above  an  alternative  method  of 
treatment  can  be  adopted,  viz. : — 

Procure  a  firm  board,  shutter  or  door  long 
enough  to  reach  from  the  patient's  head  to  a 
little  beyond  his  feet  and  just  as  wide  as  the 
patient's  body,  place  a  folded  bhxnket  upon  it 
and  roll  the  blanket  up  at  the  end  to  form  a  pil- 
low, then  after  applying  triangular  bandages  to 
the  pelvis  as  above,  carefully  lift  the  patient  onto 
the  prepared  board,  and  tie  him  to  the  board  by 


Fig.  70.— Fracture  of  the  Pelvis  put  up  on  a  Shutter. 


three  triangular  bandages,  one  folded  broad 
passing  round  the  chest,  another  folded  narrow 
passing  round  the  thighs  just  above  the  knees, 
and  another  folded  narrow  passing  round  the 
ankles  and  tied  in  a  figure  of  8.     (Fig.  70.) 

III. — Fractures    of   the   Upper  Exremity 
I.     Fracture  of  the  Collar-Bone  (Clavicle). 
Causes. '-\]s\x\.\\\y  indirect  violence,  as   a   fall 


136 


FIRST  AW    TO    THE  INJURED 


upon  the  outstretched  hand,  or  on  to  the  top  of 
the  shoulder. 

Signs. — Distortion  of  the  collar-bone,  pain  and 
crepitus  (on  pressing  the  fragments,  and  on 
rotating  the  arm  with  the  elbow  pressed  to  the 


^^K^i 


Fig.  71.— Fracture  of  the  Inner 
Third  Clavicle. 


side),  and  depression  of  the  shoulder  downward, 
forward  and  inward  (Fig.  71),   usually  causing 
the  patient  to  lean  his  head  to  the  injured  side. 
Caution. — Crepitus  by  unskilled  persons  is  not 


SFEAINS,   DISLOCATIONS,  FRACTURES  137 

to  be  tried  for,  as  this  fracture  may  very  easily  be 
made  compound  or  complicated. 

Treatment. — The  points  to  be  aimed  at  are  : 
To  correct  the  depression  of  the  shoulder,  and 
thus  prevent  the  overlapping  of  the  broken  ends 
of  the  collar-bone ;  to  keep  the  ends  of  the  bone 
in  apposition,  and  to  lessen  the  pain  by  prevent- 
ing the  motion  of  the  arm.  Therefore  proceed 
as  follows : — 

(I)  Make  a  firm  wedge-shaped  pad,  3  inches 
thick  at  the  base  and  about  the  size  of  one's  fist, 
and  place  it  well  up  into  the  armpit  with  the 
base  upward  ;  at  the  same  time,  with  the  arm 
close  to  the  side,  push  the  elbow  as  high  up  as 
possible. 

(II)  Place  the  forearm  across  the  chest  with 
the  hand  pointing  to  the  opposite  shoulder,  the 
elbow  being  well  back,  i.  e.,  behind  a  vertical 
line  dropped  from  the  point  of  the  shoulder,  and 
the  point  of  the  shoulder  well  forward,  and  with 
the  forearm  in  this  position  — 

(III)  Apply  the  broad  arm  sling  as  follows  - 
Take  a  triangular  bandage  unfolded,  pass  one 
end  of  it  under  the  bent  forearm,  and  place  this 
end  on  the  sound  shoulder,  with  the  point  of  the 
bandage  in  the  opposite  direction  to  the  elbow  of 


138 


FIRST  AID   TO    THE  INJURED 


the  injured  side  (Fig.  72) ;  now  carry  the  lower 
end  across  the  forearm,  pass  it  under  the  pad  in 
the  armpit,  draw  it  out  behind  and  tie  it  to  the 
end  lying  on  the  sound  shoulder  (Fig.  72c<^) ;  then 
neatly  fold  the  remainder  of  the  bandage  below 


Fig.  72. 


Fig.  72a. 


Fig.  726. 


Figs.  72,  72a,  72b.— Fracture  of  Clavicle  put  up— one  method. 
(Note:  In  Fig.  72  the  elbow  Is  placed  too  far  forward). 

the  point  over  the  forearm  and  pin  it  to  the 
part  above  the  hand  (Fig.  72h).  In  applying 
this  broad  arm  sling,  tighten  it  till  the  weight  of 


SFEAINi^,  Dl^LOCATIONlS,  FliAVTURES  139 

the  arm   is  entirely  taken  off  the  shoulder,  and 
the  broken  ends  of  the  bone  are  in  apposition. 

(IV)     Take  a  narrow-fold  triangular  bandage, 
])lace  the  middle  of  it  over  the  elbow  of  the  in 
jured  side  outside  the  sling,  carry  the  ends  round 
the  chest  and  tie  them  on  the  opposite  side.    (Fig. 
72J.) 

A  fractured  clavicle  may  also  be  put  up  very 
easily  by  any  of  the  following  methods  : — 

{a)  After  placing  a  pad  in  the  armpit  and  ad- 
justing the  forearm  across  the  chest  as  indicated 
above,  take  two  triangular  bandages,  folded  nar- 
row, apply  the  centre  of  one  bandage  to  the 
point  of  the  elbow  on  the  injured  side,  carry  the 
ends  obliquely  upward  across  the  chest  and  back 
to  the  opposite  shoulder,  and  tie  them  on  top  of 
it.  Now  take  the  second  bandage,  place  the 
centre  of  it  just  above  the  point  of  the  elbow  on 
the  injured  side,  carry  the  ends  across  the  body 
and  tie  them  on  the  sound  side. 

(6)  After  placing  a  pad  as  above  in  the  arm- 
pit, bend  the  forearm  across  the  body  and  apply 
the  large  arm  sling  (Fig.  Y3)  to  support  the  fore- 
arm, then  take  a  triangular  bandage  folded  nar- 
row, place  the  centre  of  it  just  above  the  elbow 
on   the  injured  side,  carry  the  ends  round  the 


140 


FIRST  AID   TO   THE  INJURED 


body  and  tie  them  on  the  opposite  side.     (Fig. 
na.) 

{c)    After  placing  a  wedge-shaped  pad  in  the 


Fig.  73.  Fig.  73a. 

Figs.  73,  73a.  —Fracture  of  the  Clavicle  put  up— anotlier  method. 

armpit  as  above,  apply  the  centre  of  a  triangu- 
lar bandage  folded  narrow  to  the  outer  surface 


SPBAINS,   DISLOCATIONS,  FRACTURES  141 

of  the  arm  of  the  injured  side,  carry  the  lioiit 
end  horizontally  across  the  chest,  bring  the  back 
end  forward  between  the  arm  and  the  chest  over 
the  upper  margin  of  the  front  part  of  the  band- 
age, then  up  through  the  loop  formed,  carry 
backward  round  the  chest,  exercising  steady 
traction  so  as  to  draw  the  arm  backward,  then 
secure  the  two  ends  on  the  opposite  side  of  the 
chest.  Now  apply  the  large  arm  sling  in  the 
same  way  as  it  is  applied  to  support  the  fore- 
arm, but  to  avoid  the  injured 
bone  from  being  pressed 
upon,  after  bringing  up  the 
low^er  end  in  front  of  the 
forearm,  pass  it  between  the 
arm  and  the  side  of  the  in- 
jured shoulder  and  tie  it  to 
the  upper  end  behind  the 
neck. 

2.     Fracture    of   the    Arm 
(Shaft  of  the  Humerus). 

Causes. — Direct  violence. 

Signs.— T\\Q   usual  ones  of    i^-^.74.-To  show  Fracture 
fracture.       (Fig*    74)  ofLower  Third  of  Humerus. 

Treatment. — (I)     Take   two  splints,  one  to 
go  along  the  outer  side  of   the   arm,  reaching 


142 


FIRST  AID   TO   THE  INJURED 


from  the  tip  of  the  shoulder  to  just  beyond  the 
point  of  the  elbow,  and  the  other  to  go  along 
the  inner  side  of  the  arm,  reaching  from  thearm- 


Fig.  75.— Fracture  of  Humerus  put  up 
with  Venetian  Blind  Laths. 


pit  to  just  below  the  point  of  the  elbow,  and  pad 
them. 

(II)     Place  a  small   pad  in  the  armpit ;  make 
gentle  extension   and  counter-extension   on   the 


SPIiAINS,   DISLOCATIONS,  FRACTURES  143 

broken  bone  to  bnug  the  ends  into  apposition, 
tlien  apply  the  splints  one  on  each  side,  and 
fix  them  above  and  below  the  seat  of  the 
fracture  by  means  of  narrow-fold  triangular 
bandages. 

Wote. — In  tying  the  splints,  the  bandage  above 
the  fracture  must  be  applied  first. 

(Ill)  Bend  the  forearm  upon  the  arm  and 
place  it  in  a  narrow  arm  sling,  allowing  the 
point  of  the  elbow  to  hang  well  down.  (Fig. 
75.) 

3.     Fracture  about  the  Elbow  Joint. 

Causes. — Direct  violence. 

Signs. — Inability  to  bend  the  elbow,  with  the 
usual  signs  of  fracture. 

Treatment.— (I)  Take  two  splints,  tie  them 
at  their  ends  in  the  form  of  a  right  angle  and 
pad  them. 

(II)  Bend  the  forearm  and  place  it  with  the 
palm  of  the  hand  to  the  body,  and  the  thumb 
pointing  upward. 

(III)  Apply  the  padded  side  of  the  L-shaped 
splint  along  the  inner  side  of  the  arm  and  fore- 
arm, and  fix  it  above  to  the  arm  and  behnv  to 
the  hand  by  means  of  narrow-fold  triangular 
bandages.     (Fig.  70.) 


144 


FIRST  AID    TO    THE  INJURED 


{{\)     Place    the    forearm   in   a   narrow   arm 


sling. 


Pig.  76.— Fracture  about  tlie  Elbow  Joint  put  up 
with  an  L  sliapetl  splint. 


4.     Fracture  of  the  Forearm  (Radius  and  Ulna). 
Causes. — Usually  direct  violence.     Both  bones 
may  be  broken  or  only  one. 


SrnA  INS,  DISLOCA  TIOKS,  FRA  CTURES 


145 


Signs. — The  usual  ones  of  fracture,  which  are 
not  so  apparent  if  only  one  bone  is  broken. 

Treatment. — (1)  Take  two  splints,  to  reach 
from  the  elbow  to  the  tips  of  tlie  fingers,  and  pad 
them. 


Fig.  77.— To  show  Fracture  of  Forearm  put  up 

with  Venetian  Blind  Latlis. 

(Note:  The  dotted  lines  indicate  the  broad  arm  sling.) 


(II)  Bend  the  forearm  upon  the  arm,  and 
place  it  with  the  palm  of  the  hand  to  the  body, 
and  the  thumb  pointing  upward. 


146  FIRST  AID    TO    THE  INJURED 

(III)  Adjust  the  splints  on  the  outer  and 
inner  side  of  the  forearm,  taking  care  tiiat  thej 
chtsp  the  lower  end  of  the  arm  in  the  same  plane 
as  the  length  of  the  arm,  and  tie  them  above  and 
below  the  fracture.     (Fig.  Y7.) 

(IV)  Place  the  forearm  in  a  large  arm  sling. 

5.  Fracture  of  the  Wrist  (Colles'  Fracture). 
Causes. — Usually  indirect  violence,  as  a   fall 

upon  the  hand. 

Signs. — The  usual  ones  of  fracture,  Avith  a  well 
marked  deformity  at  the  back  of  the  wrist. 

Treatment. — (I)  Eeduce  the  deformity  by 
extension  and  counter-extension,  and  then 

(II)  Apply  splints  in  the  same  manner  as  for 
a  fractured  forearm. 

(III)  Place  the  forearm  in  a  large  arm  sling. 

6.  Fractures  of  the  Hand  or  Fingers  (Meta- 
carpus or  Phalanges). 

Causes. — Direct  violence. 

Sigiis. — The  usual  ones  of  fracture. 

Treatment. — (I)  Take  a  splint,  to  reach 
from  the  elbow  to  the  tips  of  the  fingers,  and 
pad  it. 

(II)  Place  the  splint  along  the  inner  side  of 
the  forearm  and  hand,  and  fix  it  by  means  of 
narrow-fold  triangular  bandages. 


SPRAINS,  DISLOCATIONS,  FRACTURES  147 

(III)     Bend  the   forearm    upon  the  arm  and 
place  it  in  a  large  arm  sling. 

Caution. — After  splints  have  been  applied  to 
fractures  of  the  upper  extremity,  the  pulse  at  the 
wrist  should  always  be  felt,  in 
order  to  guard  against  undue  S?' 
compression  of  the  vessels. 

lY. — Fractures  of  the  Lower 
Extremity 

I.  Fracture  of  the  Thigh  Bone 
(Shaft  of  the  Femur). 

Causes. — Direct  or  indirect  vio- 
lence. 

Sigiis. — The  usual  ones  of  frac- 
ture, with  considerable  shortening 
of  the  limb  (Fig.  78),  and  turning 
out  of  the  foot. 

Treatment. — (I)  Place  the 
patient  comfortably  on  his  back  ; 
grasp  the  foot  on  the  injured  side 
and  while  an  assistant  steadies 
the  limb  by  holding  it  above  the 
seat  of  fracture,  make  extension 
on  the  thigh  till  the  limb  is  the 
same  length  as  the  sound  one ;  see  that  the  outer 


Fig.  78.— Fracture  of 
Upper  Third  of 
Femur. 


148  FJEST  AID   TO   THE  INJURED 

^dgQ  of  the  foot  is  perpendicular  to  the  ground, 
and  still  keeping  up  extension,  direct  an  assistant 
to  — 

(II)  Procure  two  splints,  one  to  reach  from 
the  armpit  to  two  or  three  inches  below  the  foot, 
and  the  other  to  reach  from  the  fork  to  the  knee : 
see  that  the  splints  are  padded. 

(III)  Place  two  soft  pads,  one  in  the  armpit 
and  the  other  in  the  fork,  and  then  adjust  the 
splints  respectively  to  the  outer  and  inner  sides 
of  the  thigh. 

(IV)  Fix  the  outer  splint  to  the  body  by  two 
triangular  bandages,  one  broad-fold  tied  just  under 
the  armpits,  and  the  other  narrow-fold,  tied  just 
above  the  hips.     (Fig.  79.) 

(Y)  Now  fix  the  inner  splint  to  the  thigh  by 
tying  two  narrow-fold  triangular  bandages  one 
above  and  the  other  just  below  the  seat  of  fracture. 

(VI)  Then  with  two  similar  bandages  tie  the 
outer  splint  to  the  leg,  just  below  the  knee  and  a 
little  above  the  ankle. 

(VII)  Secure  the  sound  to  the  injured  limb  by 
tying  together  the  two  feet  by  a  narrow-fold 
bandage  passed  behind  the  ankles,  carried  over 
the  instep,  crossed,  and  tied  below  the  soles  of 
the  feet. 


SPEAINS,  J)1SL0(JATI0NS,  FRACTURES 


149 


(f^^ 


,/ 


* 


150  FIRST  AW    TO    THE  INJURED 

(VIII)  Lift  the  patient  on  to  a  stretcher,  and 
phice  hiin  inclining  somewhat  toward  the  injured 
side. 

(IX)  Kernove  him  on  the  stretcher  and  place 
him  on  a  fracture  bed  {see  Chapter  X),  making 
him  lie  as  flat  as  possible,  with  only  a  very  low 
pillow  for  his  head. 

The  test  of  efficient  splinting  for  fracture  of 
the  femur  is,  that  the  patient  should  be  able  to 
be  carried  by  the  head  and  heels  without  any 
bending,  but  the  actual  removal  of  the  patient  in 
this  manner  should  never  be  attempted. 

A  Rifle  Splint  may  be  applied  to  a  fractured 
thigh  as  follows  :  "  If  an  old  pattern  rifle  is  used, 
see  that  the  rifle  is  not  loaded.  Place  it  on  the 
side  of  the  injured  limb,  butt  in  the  armpit, 
trigger  guard  to  the  front;  place  a  pad  in  che 
armpit ;  take  a  narrow-fold  bandage^  place  its 
centre  over  the  ankle  of  the  injured  limb,  pass 
the  ends  behind  enclosing  muzzle  of  rifle,  cross 
behind  ;  with  the  outer  end  take  a  turn  round  the 
muzzle,  in  front  of  the  sight  for  sling ;  bring 
both  ends  up,  cross  over  instep,  and  tie  off  on  the 
inside  of  the  foot.  Take  a  narrow-fold  ;  place  its 
centre  on  the  perineum,  bring  one  end  out  be- 
hind  the  other  in  front  of  the  limb,  cross  the 


SPRAINS,  DISLOCAflONS,   FRACTURES  151 

ends  through  the  trigger  guard,  take  a  turn 
round  the  small  of  the  butt,  just  above  the  trigger 
guard,  and  tie  off.  Take  two  long  splints ;  place 
one  on  the  top  and  the  other  along  the  inner  side 
of  the  thigh,  and  fix  at  each  end  by  a  narrow- 
fold,  tied  off  over  the  rifle.  Take  a  broad-fold 
bandage ;  place  the  centre  over  the  butt  of  the 
rifle,  pass  the  ends  round  the  body  and  tie  off  on 
the  opposite  side.  Tie  the  patient's  legs  to- 
gether by  placing  the  centre  of  a  broad-fold 
bandage  over  both  ankles,  pass  the  ends  behind, 
cross,  bring  up  and  tie  off  on  top  between  the 
legs."     (Fig.  80.) 

With  the  new  magazine  rifle,  a  fractured  thigh 
is  put  up  as  follows  : — 

"  See  that  the  rifle  or  magazine  contains  no 
cartridges.  If  the  splint  be  for  the  right  side 
remove  the  bolt.  Take  a  narrow-fold  bandage, 
phice  it  over  the  heel  plate  of  butt  in  such  a  way 
that  two-thirds  of  its  length  are  on  what  will  be 
the  outer  side,  and  one-third  on  the  other  side  of 
the  butt ;  take  a  half  hitch  with  the  long  end 
round  the  butt,  making  a  half  knot  on  the  outer 
side,  tie  the  ends  with  a  reef  knot  so  as  to  form  a 
loop,  the  knot  of  which  must  come  below  the 
stock  and  be  on  a  level  with  the  projecting  part. 


152  FIRST  AID    Ti)    THE  INJURED 

This  is  for  the  perineal  bandage  to  i)ass  through, 
and  is  called  the  butt  loop ;  leave  the  magazine  in 
position,  place  tiie  rifle  along  the  injured  limb, 
butt  toward  the  armpit,  trigger  guard  to  the 
front.  Take  a  narrow-fold  bandage,  place  its 
centre  over  the  ankle  of  the  injured  limb,  pass 
the  ends  behind  enclosing  muzzle  of  rifle,  cross 
behind,  with  the  outer  end  take  a  turn  round  the 
muzzle  in  front  of  the  sight  or  for  sling,  bring 
both  ends  up,  cross  over  instep  and  tie  off  on  the 
inside  of  the  foot.  Take  a  narrow-fold  bandage, 
place  its  centre  on  the  perineum,  bring  one  end 
out  behind  the  other  end  in  front  of  the  limb, 
pass  one  end  through  the  butt  loop  and  tie, 
gradually  tightening  the  knot  as  the  limb  is 
gently  drawn  to  its  proper  length  :  pass  both 
ends  round  small  of  butt  and  tie  off.  Take  two 
long  splints,  place  one  on  the  top  and  the  other 
along  the  inner  side  of  the  thigh,  and  fix  at  each 
end  by  a  narrow-fold  bandage  tied  off  over  the 
rifle.  Take  a  broad-fold  bandage,  place  the  cen- 
tre over  the  butt  of  the  rifle,  pass  the  ends  round 
the  body  and  tie  off  on  the  opposite  side.  Tie 
the  patient's  legs  together  by  placing  the  centre 
of  a  broad-fold  bandage  over  both  ankles,  jiass 
the  ends  behind,  cross,  bring  up  and  tie  off  on  top 


SriiAINS,   DL^LOCATIOiWS,   FRACTURES  153 

between  the  legs "  {Manual  foi'  the  Royal 
Army  Medical  Co?'jJSy  1899). 

2.     Fracture  of  the  Knee-cap  (Patella). 

Causes. — Usually  muscular  action. 

Signs. — Inability  to  move  the  leg  and  bend  the 
knee  ;  a  considerable  interval  can  also  as  a  rule  be 
felt  between  the  fragments.     (Fig.  81.) 


Fig.  81.— Fracture  of  the  Patella. 

Treatment. — (I)  Take  a  splint  long  enough 
to  reach  from  the  buttock  to  the  heel,  and  pad  it. 

(II)  Extend  the  leg  and  place  the  splint  along 
the  back  of  the  thigh. 

(III)  Tie  the  splint  to  the  leg  by  means  of 
two  narrow-fold  triangular  bandages,  placing  one 
round  the  thigh  and  the  other  round  the  leg. 

(IV)  Take  two  narrow-fold  triangular  band- 
ages, and  tie  them  above  and  below  the  broken 
fragments,  crossing  the  lower  obliquely  over  the 
upper  at  the  sides,  thus  making  a  figure  of  8. 
(Fig.  82.) 

(V)  Fix   the   sound   to  the  broken  limb  by 


154 


FIRKV  AID    TO    THE  INJURED 


/ 


SriiAIAIS,  DJSLOCATlOiXS,  FUACiURES 


loo 


tying  the  two  feet  together  in  the  manner  indi- 
cated on  page  148. 

(VI)  lieinove  the  patient  on  a  stretcher,  and 
place  him  in  bed  in  the  same  way  as  for  a  frac- 
tured thigh. 

3.     Fracture  of  the  Leg  (Tibia  and  Fibula). 

Causes. — Direct  or  indi- 
rect violence.  One  or  both 
bones  may  be  broken. 

Signs. — The  usual  ones  of 
fracture. 

T  R  E  A  T  M  E  N  T. — (I)      Be 

careful  in  handling  the 
broken  limb,  and  especially 
so  if  the  tibia  (shin  bone)  is 
broken,  as  this  fracture  may 
very  easily  be  made  a  com- 
pound one. 

(II)  Procure  two  splints, 
both  to  reach  from  a  little 
above  the  knee  to  just  be- 
yond the  foot ;  after  padding, 
adjust  them  to  the  outer  and 
inner  sides  of  the  broken 
limb,  and  fix  them  above  and  below  the  seat  of 
the  injury  by  narrow-fold  triangular  bandages. 


Fig.  84.— Fracture  of  the 
Tibia. 


156  FIEST  AID    TO    THE   INJURED 

(III)  Fix  the  sound  to  the  broken  limb  by 
tying  the  feet  together,  as  indicated  on  page  148. 

(IV)  Remove  the  patient,  and  place  him  in 
bed  in  the  same  way  as  for  a  fractured  thigh. 

4.     Fracture  of  the  Bones  of  the  Foot  (Tarsus). 

Causes. — Usually  direct  violence.  This  frac- 
ture is  very  often  compound. 

Signs. — The  usual  ones  of  fracture. 

Treatment. — The  same  as  that  for  fracture 
of  the  leg ;  after  the  patient  has  been  put  to  bed, 
elevate  the  foot  by  placing  a  small  pillow  be- 
low it. 


CHAPTER  VI 

ARTIFICIAL    RESPIRATION   AND   THE   TREAT- 
MENT  OF   ASPHYXIA 

Artificial  Respiration,  methods  of  :  The  Sylvester,  the  Howard, 
the  Marshall  Hall— Asphyxia  :  definition,  causes  and  treat- 
ment of— The  treatment  of  the  Apparently  Drowned— 
The  treatment  of  Asphyxia  from  Choking,  from  Obstruc- 
tion of  the  Larynx  by  Swelling  of  the  Mucous  Membrane, 
from  Attempted  Hanging  or  Strangulation,  and  from 
Breathing  Irrespirable  and  Poisonous  Gases — The  Appear- 
ances which  accompany  Death. 

ARTIFICIAL  RESPIRATION 
Various  methods  have  been  proposed  for  per- 
forming artificial  respiration.     Those  most  usu- 
ally adopted  are  : — 

1.  Dr.  Sylvester's  Method. 

2.  Dr.  Benjamin  Howard's  "  Direct  Method." 

3.  Dr.  Marshall  Hall's  "  Ready  Method." 

I.    The  Sylvester  Method. — This  method  has 
the  following  points  to  recommend  it: — 
(I)     It  is  simple. 

157 


158  FIRST  AID    TO    THE  INJURED 

(II)  It  is  effective. 

(III)  It  is  to  a  great  extent  in  harmony  with 
the  process  of  natural  respiration. 

(lY)  The  expansion  of  the  thorax  is  arti'fi- 
ciiilly  insured,  and  the  metiiod  is  wholly  under 
the  control  of  the  operator. 

(V)  The  patient  is  not  liable  to  be  injured  by 
the  manipulations. 

(Yl)  Both  sides  of  the  chest  are  equally  in- 
flated and  a  large  amount  of  air  is  inspired. 

(YII)  The  adoption  of  the  method  is  easy. 
It  can  be  remembered  and  it  can  be  efficiently 
put  into  operation  by  one  person. 

Mode  of  Procedure. — Lay  the  patient  flat  on 
his  back  on  the  floor,  loosen  all  tight  clothing 
about  the  neck,  chest  and  abdomen,  and  loosen 
the  braces  ;  place  a  block  or  hard  pillow  under 
the  patient's  shoulders  (in  order  to  raise  the  chest, 
extend  the  neck  and  throw  the  head  back),  draw 
forward  the  tongue  and  get  an  assistant  to  hold 
it  in  the  corner  of  a  handkerchief  between  the 
thumb  and  finger;  if  unassisted,  fasten  the 
tongue  round  the  chin  bv  an  indiarubber  band 
or  a  piece  of  string. 

Now  kneel  at  the  patient's  head  ;  take  hold  of 
his  arms  above  the  elbows  and  carry  them  well 


ARTIFICIAL  RESPIRATION  159 

over  the  head  as  far  back  as  they  will  go  (Fig-. 
S5ri) ;  this  will  have  the  effect  of  expanding 
die  chest.  Hold  the  arms  in  this  position  for 
Lwo  seconds,  then  bring  them  down  against  the 
ribs,  cross  the  forearms  over  the  pit  of  the 
stomach,  and,  kneeling  well  forward,  make  steady 
pressure  upon  the  sides  and  front  of  the  chest 
(Fig.  86^),  keep  up  this  pressure  for  two  seconds. 
This  will  have  the  effect  of  expelling  the  air 
from  the  chest. 

Repeat  the  above  movements  carefully  and  de- 
liberately about  fifteen  times  a  minute  till  the 
natural  respiration  becomes  established.  This 
will  be  indicated  by  the  patient  beginning  to  take 
short  gasps.  Then  cease  the  movements,  but 
watch  the  patient  carefully  for  some  time,  as  the 
respiration,  after  being  once  established,  is  again 
liable  to  fail  and  may  have  to  be  restored. 

If  the  expansion  and  the  compression  of  the 
chest  are  efficiently  performed,  the  flow  of  air  in 
and  out  of  the  larynx  can  be  distinctly  heard. 

2.  Dr.  Benjamin  Howard's"  Direct  Method." — 
This  method  has  the  advantage  that  it  can  be 
used  in  cases  where  there  is  injury  to  the  arms. 

It  is  more  vigorous  than  the  "  Sylvester 
method,"  and  it  is  easily  put  into  practice,  but  it 


im 


FIRST  AID   TO   THE  INJURED 


AUTIFICIAL   RESPIRATION  161 

has  Lbe  disadvantage  that,  if  forcible  pressure  is 
used  by  an  unskilled  operator,  the  patient  runs 
the  risk  of  being  injured  during  its  performance. 

Mode  of  Procedure. — Lay  the  patient  fiat  on 
his  back,  put  a  hard  pillow  or  roll  of  clothing 
(hirger  than  that  used  in  the  "  Sylvester  method  ") 
well  under  the  back  in  order  that  the  lower  part 
of  the  chest  may  be  the  highest,  place  the  patient's 
forearms  crossed  on  the  top  of  the  forehead,  and 
strip  the  clothing  from  the  waist  and  neck. 

Now  kneel  astride  the  patient's  hips,  facing 
his  head,  place  the  hands,  with  the  fingers  spread 
well  apart,  on  the  most  compressible  part  of  the 
lower  ribs,  taking  care  that  the  thumbs  do  not 
press  upon  the  pit  of  the  stomach,  and  squeeze 
together  the  two  sides  of  the  patient's  chest  at 
the  same  time,  leaning  gradually  forward  till  the 
whole  weight  is  over  the  patient  and  the  mouth 
is  nearly  touching  that  of  the  patient's ;  remain 
in  this  position  for  two  seconds,  then  spring  back 
to  the  kneeling  position,  lifting  the  hands  off  the 
patient's  sides. 

Continue  these  movements  at  the  rate  of  about 
fifteen  a  minute  till  the  respiration  becomes 
established. 

3.     Dr.   Marshall    Hall's    "  Ready   Method."— 


W^i  FIRST  AID    TO   THE  INJURED 

This  is  the  least  efficient  of  the  three  methods, 
as  only  one  side  of  the  chest  is  compressed,  and 
expansion  of  the  lung  can  only  take  place  on  the 
non-compressed  side. 

It  is  also  the  mildest ;  it  requires  considerable 
practice  before  one  can  be  efficient  in  it ;  and  it 
needs  three  persons  to  perform  it. 

Mode  of  Procedure. — Take  up  a  position  on 
the  left  side  of  the  patient,  make  one  assistant 
kneel  at  the  patient's  head  and  another  assistant 
at  the  patient's  feet,  place  a  hard  roll  of  clothing 
(which  must  be  twice  as  long  as  that  used  in 
Howard's  method)  in  such  a  manner  that  when 
the  patient  is  turned  over  his  chest  will  be  across 
the  roll. 

Now  with  the  help  of  the  two  assistants  turn 
the  patient  face  downward,  making  the  body  in- 
cline over  the  roll  of  clothing,  and  make  firm 
pressure  with  the  hand  upon  the  Back,  between 
and  on  the  shoulder  blades,  then  turn  the  body 
on  the  side  again.  In  turning  the  patient  the 
assistant  at  the  head  must  see  that  the  patient's 
arms  are  not  laid  upon  or  twisted. 

Repeat  these  movements  and  continue  them  at 
the  rate  of  fifteen  a  minute  till  respiration  be- 
comes established. 


ASPHYXIA   AND  ITS  TREATMENT  163 

ASPHYXIA  AND  ITS  TREATMENT 

Definition. — By  asphyxia  is  meant  the 
condition  which  supervenes  when  the  function 
of  respiration  has  been  interrupted.  Death 
from  asphyxia  is  due  to  carbonic  acid  gas 
poisoning. 

Asphyxia  may  be  caused  by  : — 

(I)  Submersion  in  a  liquid  medium,  as  in 
drowning. 

(II)  Stopping  up  of  the  air  passages  by  foreign 
bodies,  as  in  choking. 

(III)  Pressure  on  the  chest,  preventing  the 
a(^.tion  of  the  respiratory  muscles. 

(lY)  Closure  of  the  air  passages,  as  in  suffo- 
cation or  smothering. 

(Y)  External  pressure  on  the  air  passages,  as 
in  strangulation  or  hanging. 

(YI)  Breathing  irrespirable  gases,  such  as 
nitrogen,  hydrogen,  carbonic  oxide,  sulphuretted 
hydrogen,  chlorine,  chloroform  vapor,  etc. 

The  Treatment  of  Asphyxia. — For  some 
minutes  (about  four)  after  the  respirations  have 
entirely  stopped  the  heart's  action  continues,  and 
as  long  as  the  heart  beats  recovery  from  asphyxia 
is  possible. 


164  FIRST  AW   TO   THE  INJURED 

The  main  indications  for  treatment  are: — 

(I)  To  remove  as  quickly  as  possible  the  cause 
of  the  asphyxia. 

(II)  To  effect  the  purification  of  the  blood  by 
introducing  fresh  air  into  the  lungs  by  means  of 
artificial  respiration  or  otherwise. 

The  Treatment  of  Apparent  Death  from  Drown- 
ing.— The  appearances  presented  by  a  person  who 
has  been  immersed  for  some  time  in  the  water 
are  as  follows  : — 

The  face  is  swollen  and  purple,  the  lips  are 
livid,  the  eyes  are  blood-shot,  the  mouth,  wind- 
pipe and  lungs  contain  frothy  fluid,  there  is  a 
considerable  quantity  of  water  in  the  stomach, 
the  feet  and  hands  may  be  swollen  and  discol- 
ored, and  the  body  is  cold. 

In  treating  the  apparently  drowned  the  follow- 
ing factors  have  to  be  borne  in  mind  : — 

(I)  The  condition  of  asphyxia  due  chiefly  to 
submersion,  but  also  to  the  blocking  of  the  air 
passages  with  water,  mud,  etc. 

(II)  The  shock  to  the  system. 

(III)  The  exhaustion  from  long-continued 
struggling. 

(lY)     The  effect  of  exposure  to  the  cold. 
The  most  important  factor,  however,  in  treat- 


ASPHYXIA    AND   ITS   TREATMENT  165 

ment  is  to  remove  the  condition  of  asphyxia  as 
soon  as  possible  by  artificial  respiration. 

Directions  for  Restoring  the  Apparently 
Drowned : — 

(I)  Send  at  once  for  medical  assistance, 
blankets  and  dry  clothing,  in  the  meanwhile  — 

(II)  Immediately  proceed  to  treat  the  patient 
on  the  spot,  by  first  restoring  the  breathing,  and, 
after  the  breathing  has  been  restored,  by  pro- 
moting warmth  and  circulation.  It  is  important 
not  to  attempt  to  restore  the  circulation  till  the 
breathing  has  recommenced,  as  by  over-taxing  an 
already  dilated  heart  life  is  endangered. 

To  Restore  Natural  Breathing,  proceed  as  fol- 
lows : — 

(cc)  Clear  the  Air  Passages. — To  effect  this, 
first  remove  all  tight  clothing  constricting  the 
neck  and  chest,  then  turn  the  patient  face  down- 
ward, placing  a  firm  roll  of  clothing  under  his 
stomach  and  chest,  and  one  of  his  arms  under  the 
forehead  so  as  to  raise  the  mouth  off  the  ground, 
now  press  firmly  two  or  three  times,  for  four  or 
five  seconds  each  time,  upon  the  patient's  back, 
this  will  have  the  effect  of  draining  off  water 
from  the  lungs  and  stomach. 

(Jj)     Adjicst  the  Patient's  Position^  by  turning 


166  FIEST  AID   TO    THE  INJURED 

bill!  on  to  his  back  with  the  roll  of  clothing  unde^ 
liis  shoulder  blades,  and  allowing  the  head  to  fall 
back. 

(c)  Maintain  a  Free  Entrance  of  Air  Into 
the  Windpipe. — To  do  this  examine  the  mouth 
and  remove  from  it  all  weeds,  mud,  lumps  of 
food,  etc. ;  draw  forward  the  patient's  tongue  and 
keep  it  projecting  beyond  the  lips  by  an  elastic 
band  or  a  piece  of  tape  or  string  passed  over  it  and 
under  the  chin  ;  look  to  the  nostrils  and  free  them 
from  any  obstructions. 

{d)  Iiaitate  the  Movements  of  Breathing.,  i  <?., 
perform  '-'  Sylvester's  Method  "  of  Artificial  Kes- 
piration,  and  continue  it  till  the  patient  makes  an 
effort  to  breathe. 

(e)  Encourage  Breathing. — If  any  assistants 
are  at  hand  during  the  performance  of  artificial 
respiration,  get  them  to  excite  the  nostrils  with 
snuff  or  smelling  salts,  or  to  tickle  the  throat 
with  a  feather,  also  to  rub  the  face  and  chest 
briskly. 

While  artificial  respiration  is  being  performed, 
make  those  who  are  assisting  dry  the  patient's 
hands  and  feet,  and  (if  warm  clothing  has  been 
procured),  to  strip  off  the  wet  clothes  and  replace 
them  with  dry  ones,  but  in  doing  this,  the  efforts 


A;srHVXIA    AND   ITS   TREATMENT  167 

to  restore  respiration  must  not  be  hindered.  As 
soon  as  breathing  has  commenced  proceed  to 
promote  warmth  and  circulation.  To  do  this, 
wrap  the  patient  up  in  dry  blankets  and  com- 
mence rubbing  the  limbs  upward,  firmly  and 
energetically,  with  warm  flannels  or  cloths, 
either  under  the  blankets  or  over  the  dry  cloth- 
ing. Apply  hot  flannels,  hot  water  bottles,  hot 
bricks,  etc.,  to  the  pit  of  the  stomach,  to  the  arm- 
pits, between  the  thighs,  and  to  the  soles  of  the 
feet. 

When  the  patient  is  able  to  swallow,  give  him 
small  quantities  of  wine,  warm  brandy  and  water, 
or  hot  coffee. 

Put  the  patient  to  bed  and  encourage  sleep. 
During  the  period  of  reaction  the  breathing  may 
become  oppressed.  To  obviate  this,  apply  large 
linseed  meal  and  mustard  poultices  to  the  chest 
and  back.  Watch  the  patient  carefully  for  some 
time  to  see  that,  the  breathing  does  not  again 
fail ;  if  any  signs  of  failure  appear,  resume  arti- 
ficial respiration. 

JS'ote. — The  above  efforts  to  restore  life  must 
be  persevered  in  until  the  arrival  of  medical 
assistance  or  until  the  pulse  and  breathing  have 
ceased  for  at  least  an  hour. 


168  FIRST  AID    TO    THE  INJURED 

Cautions. — The  following  are  to  be  borne  in 
mind  : — 

(I)  Avoid  delay  in  the  application  of  measures 
to  restore  life. 

(II)  Do  not  waste  much  time  in  the  preliminary 
operations,  i.  e.^  in  clearing  the  air  passages,  ad- 
justing the  patient's  position,  and  maintaining  a 
free  entrance  of  air  into  the  windpipe,  but  pro- 
ceed to  perform  artificial  respiration  as  quickly 
as  possible. 

(III)  Prevent  crowding  round  the  patient, 
especially  if  in  an  apartment. 

(IV)  Avoid  rough  usage,  and  do  not  allow  the 
body  to  remain  on  the  back  unless  the  tongue  is 
secured. 

(Y)  Avoid  attempts  to  give  stimulants  till  the 
patient  is  well  able  to  swallow. 

(VI)  In  performing  artificial  respiration  avoid 
hurried  and  irregular  motions. 

(VII)  Avoid  an  overheated  room. 

(VIII)  Under  no  circumstances  hold  the  body 
up  by  the  feet. 

(IX)  On  no  account  place  the  patient  in  a 
warm  bath  unless  under  medical  observation. 

(X)  Avoid  giving  up  hope  for  the  patient  too 
soon. 


ASmrXJA    AND  ITS   TBEAIMENT  169 

Asphyxia  from  Choking.— Chokico^  is  caused  by 
bits  of  food,  foreign  bodies,  etc.,  accidentally 
passing  into  the  larynx. 

Treatment. — Send  at  once  for  medical  as- 
sistance, but  in  the  meanwhile  make  attempts  to 
dislodge  the  obstruction  by  first  placing  the 
patient  in  the  recumbent  position  with  the  head 
turned  on  one  side,  and  then  passing  the  linger 
or  the  handle  of  a  spoon  over  the  base  of  the 
tongue,  and  clawing  forward  with  it.  If  the 
patient  happens  to  be  a  child,  it  may  be  held  up 
by  the  feet  and  slapped  on  the  back.  If,  after 
the  foreign  body  has  been  extracted,  there  are  no 
signs  of  breathing,  begin  artificial  respiration  at 
once  and  continue  it  for  at  least  an  hour. 

Asphyxia  from  Blocking  of  the  Larynx,  Caused 
by  Swelling  of  the  Mucous  Membrane. — Suffo- 
cation in  children  is  often  caused  by  attempting 
to  drink  from  the  spout  of  a  kettle  containing 
boiling  water. 

Treatment. — Send  at  once  for  medical  as- 
sistance, but  in  the  meanwhile  wrap  the  child  in 
a  blanket,  apply  hot  sponges,  hot  flannels  (dry  or 
moist)  to  the  mouth ;  administer,  in  dessert- 
spoonful doses,  salad,  linseed,  or  cod  liver  oil, 
and  also  give  pieces  of  ice  to  suck. 


170  FIRST  AID   TO   THE  INJURED 

Asphyxia  from  Attempted  Hanging  or  Strangu- 
lation. 

Treatment. — Release  the  patient  at  once, 
loosen  or  cut  any  cords  which  may  be  round  his 
neck,  also  all  tight  clothing;  allow  a  free  current 
of  air  to  pass  over  his  face,  dash  cold  water  on 
his  face  and  chest,  and  perform  artificial  respi- 
ration. 

Asphyxia  from  Breathing  Irrespirable  and 
Poisonous  Gases. — These  gases  include  the  va- 
pors from  charcoal,  coal  and  coke,  lime,  brick 
and  cement  kilns,  coal  gas,  the  foul  air  from 
sewers,  cesspools  and  mines  (choke  damp),  the 
vapor  of  chloroform,  etc. 

Treatment. — Remove  the  patient  at  once 
from  the  foul  into  the  fresh  air,  loosen  all  tight 
clothing,  commence  artificial  respiration  after 
drawing  the  tongue  forward  and  securing  it,  at 
the  same  time  apply  friction  and  warmth  to  the 
body,  and  dash  cold  water  upon  the  head  and 
face. 

The  Appearances  which  generally  accompany 
Death  are  as  follows  : — 

1.  The  breathing  is  absent,  there  is  no  move- 
ment of  the  chest,  no  air  can  be  heard  passing 
in  and  out  of  it,  and  there  is  no  watery  vapor 


ASPHYXIA    AND  ITS   TKEATiMENT  171 

proceeding  from  the  mouth.  To  determine  the 
presence  of  respiration  place  a  glass  of  water  on 
the  chest  and  watch  if  any  movement  is  com- 
municated to  it ;  also  hold  a  looking-glass  or  some 
bright  surface  to  the  mouth  and  see  if  the  sur- 
face becomes  dimmed  by  vapor  condensing 
upon  it. 

2.  The  heart's  action  has  stopped,  there  is  no 
pulse,  the  movements  and  sounds  of  the  heart 
have  ceased. 

To  determine  this,  tie  a  ligature  tightly  round 
a  finger.  If  there  is  any  circulation  the  end  of 
the  finger  will  become  reddened  and  the  string 
will  leave  a  white  ring  round  the  finger. 

3.  The  eyelids  are  generally  half  closed  and 
the  pupils  are  dilated. 

4.  The  coldness  and  pallor  of  the  surface  of 
the  body  increase. 


CHAPTER  YII 

POISONS     AND    THEIR    IMMEDIATE    TREATMENT 

Poisons — Definition  and  Classification  of— Evidence  of  Poison- 
ing— How  afforded— How  to  act  in  a  Case  of  Poisoning — 
The  General  Treatment  applicable  to  a  Case  of  Unknown 
Poisoning — Special  Poisons,  their  Syniptous  and  General 
Treatment. 

Definition. — Poisons  may  be  defined  as  sub- 
stances whicli  (when  introduced  into  the  body 
or  applied  externally)  injure  health  or  destroy 
life. 

Classification. — Poisons  may  be  classed  as 
follows : — 

I.  Corrosives. — These  soften  and  destroy  the 
parts  with  which  they  come  in  immediate  con- 
tact. As  examples  of  corrosive  poisons  may  be 
mentioned — the  mineral  acids,  the  caustic  alka- 
lies, corrosive  sublimate,  the  acid,  alkaline  and 
corrosive  salts  (chlorates  of  zinc,  tin  and  anti- 
mony, nitrate  of  silver,  sulphate  of  potassium  and 
carbonate  of  potassium),  oxalic  acid,  etc. 
172 


POISONS  AND  THEIR  131  MEDIATE  TREATMENT    173 

2c  Irritants. — These  cause  inflammation  of  the 
part  (usually  the  alimentary  canal)  to  which  they 
are  applied.  As  examples  of  irritant  poisons 
may  be  mentioned— arsenic,  the  salts  of  zinc,  and 
other  metals,  elaterium,  the  essential  oils,  Span- 
ish fly. 

3.  "^Narcotics.— These  act  chiefly  upon  the 
nervous  system,  producing  stupor,  delirium,  con- 
vulsions or  coma.  As  examples  of  narcotic 
poisons  may  be  mentioned— opium,  prussic  acid, 
belladonna,  chloroform,  chloral,  alcohol,  the 
poisonous  gases,  etc. 

4.  Narcotic-Irritants.— These  combine  more  or 
less  the  characters  of  narcotics  and  irritants.  As 
examples  of  narcotic-irritants  may  be  mentioned 
—strychnia,  aconite,  hemlock,  poisonous   fungi, 

etc. 

Evidence  of  Poisoning  is  afforded  by  the  follow- 
ing circumstances,  viz  : — 

(1)  By  the  sudden  appearance  of  the  general 
symptoms  of  poisoning,  such  as  vomiting,  purg- 
ing, cramps  in  the  limbs,  pains  in  the  stomach  or 
bowels,  delirium,  unconsciousness,  etc.,  in  a  person 
otherwise  healthy,  or  soon  after  partaking  of 
food,  drink  or  medicine. 

(2)  By  several    persons  being  attacked   with 


174  FIRST  AID    TO    THE  INJURED 

similar  severe  symptoms,  soon  after  a  meal  of 
which  all  have  partaken. 

(3)  By  the  nature  of  the  surroundings,  i.  e.^ 
by  finding  a  glass  or  bottle  with  suspicious  look- 
ing contents,  by  the  smell  of  the  room,  etc. 

(4)  By  the  history  of  the  case,  i.  e.,  by  the 
patient  having  previously  shown  a  suicidal  tend- 
ency, or  the  signs  of  mental  depression,  etc. 

How  to  act  in  a  Case  of  Poisoning  : — 

(I)  Send  at  once  for  medical  assistance,  and 
take  care  that  the  doctor  is  made  acquainted 
with  the  fact  that  the  case  to  which  he  is  sum- 
moned is  one  of  probable  poisoning. 

(II)  During  the  absence  of  skilled  attendance, 
act  as  follows,  viz. : — 

(ct)  If  you  are  m  doubt  as  to  the  nature  of  the 
poison  taken^  adopt  the  general  treatment  ap- 
plicable to  a  case  of  unknown  poisoning  (see 
below). 

{h)  If  you  are  aware  of  the  nature  of  the 
poison  tal<:en,  adopt  the  general  treatment  ap- 
plicable to  the  special  poison  (indicated  in  the 
table  given  below). 

The  General  Treatment  applicable  to  a  Case  of 
Unknown  Poisoning. — Here  the  objects  to  be 
aimed  at  in  treatment  are  :  — 


POISONS  AND  THKin  IMMEDIATE  TREATMENT    175 

(I)  To  get  rid,  if  possible,  of  the  unabsorbed 
poison  from  the  system ;  this  is  effected,  either 
by  administering  an  emetic  to  bring  the  poison 
up,  or  an  aperient  to  pass  the  poison  through  the 
alimentary  canal. 

(II)  To  counteract  depression  and  shock,  by 
giving  stimulants  and  nourishments,  and  by  the 
application  of  warmth  by  means  of  poultices,  hot 
fomentations,  etc. 

(III)  To  relieve  pain,  by  administering  seda- 
tives and  demulcents. 

Emetics. — The  following  may  be  used  :  — 

Sulphate  of  Zinc,  grs.  xx  to  xxx  in  half  a 
tumbler  of  warm  water ;  this  is  prompt  and  safe, 
but  is  not  to  be  given  if  salt  and  water  has  been 
already  administered. 

Ipecacuanlia  Powder^  grs.  xv  to  xxx  in  half  a 
tumbler  of  warm  water  ;  this  produces  very  little 
depression  and  does  not  irritate  the  stomach. 

Ipecaeuanha  Wine,  1  to  2  tables poonfuls  in  an 
equal  quantity  of  water;  this  produces  a  good 
deal  of  depression  and  is  not  very  prompt  in  its 
action. 

Mustard.,  a  tablespoonful  in  a  tumbler  of  warm 
water. 

Salt,  two  tablespoonfuls  in  a  tumbler  of  warm 


176  FIRST  AID    TO   THE  INJURED 

water.  This  is  not  to  be  given  after  sulphate  of 
zinc. 

Tepzd  Fater,  in  large  draughts,  followed  by 
irritation  of  the  back  of  the  throat  by  means  of 
the  finger  or  a  feather. 

Any  of  the  above  emetics  may  be  repeated 
once  or  twice  if  necessary.  The  action  of  an 
emetic  is  facilitated  by  giving  plenty  of  tepid 
water. 

It  is  important  to  remember,  that  patients  suf- 
fering from  narcotic  poisoning  are  not  easily 
made  to  vomit. 

Caution. — Emetics  are  not  to  be  given  in 
cases  of  corrosive  poisoning,  which  is  indicated 
by  stains  on  the  lingers,  the  lips,  in  the  mouth,  etc. 

Aperients. — The  following  may  be  given  : — 

Castor  Oil,  one  to  two  tablespoonfuls  for  a  dose. 

Sulphate  of  Magnesia  (Epsom  Salts),  a  table- 
spoonful  in  a  tumbler  of  warm  water  ;  to  be  re- 
peated if  necessary. 

Stimulants. — Administer  : — 

Sal  Volatile  (Aromatic  Spirits  of  Ammonia), 
one  half  to  a  teaspoonful  in  a  tablespoonful  of 
warm  water. 

Spirits  (Brandy  or  Whiskey),  from  a  teaspoon- 
ful to  atablespoonful,  according  to  circumstances. 


POISOKS  AND  THEIR  IM3rEDIATE  TREATMENT    177 

Strong  Beef  Tea^  Tea  or  Coffee. 

The  Hot  and  Cold  Douche  alternately. 

Note. — It  may  (in  cases  where  the  patient  is 
unable  to  swallow)  be  necessary  to  give  spii'its, 
beef  tea,  tea  or  coffee  by  an  enema,  (injection 
into  the  bowels.) 

Sedatives  and  Demulcents.— These  are  non-irri- 
tating tliiids  (which  soothe  internal  local  irrita- 
tion and  relieve  pain),  such  as  milk,  raw  ^gg^, 
barley  water,  arrowroot.  Hour  mixed  in  water, 
olive  oil,  linseed  tea,  gruel,  etc. 

THE  POISONS 


Special  Poisons. 

I.  The  Acids— 

(rt)  The  strong  cor- 
rosive ones,  viz.  :  — 
(I)  Acetic  (Gla- 
cial, and  Aromatic 
Vinegar). 

(II)  Hydrochloric 
(Muriatic,  Spirits 
of  Salt). 

(III)  Nitric(Aqua 
fortis). 

(IV)  Sulphuric 
(Oil  of  Vitrol). 


Their  Symptoms. 


Immediate  burning 
pain  in  the  mouth, 
throat,  and  stomach, 
vomiting  and  purging 
may  occur.  Wher- 
ever the  skin  and 
mucous  membrane 
are  touched  they  are 
destroyed,  there  is 
more  or  less  suffoca- 
tion and  great  shock. 


Their  General  Treatment. 

I  CAMTioti.-Efnetiis 
are  not  to  be  given . 

I  A  d  m  i  n  i  s  ter  fie- 
quently  magnesia  or 

j  clialk  dissolved  in 
warm  water,  then  de- 
m  u  1  c  e  n  ts,  such  as 

I  lime  water  and  milk, 
milk  and  egg,  olive 
oil,  ^  pint  to  I  pint 
of  water,  thick  gruel ; 
if  there  is  depression, 
give  stimulants.  If 
any  acid  has  got  into 
the  air  passages, make 
the  patient  inliale  the 
fumes  of  ammonia. 


178 


FIRST  AID   TO   THE  INJURED 


Special  Poisons. 


(V)  Carbolic 

(Phenol). 


(VI)     Oxalic 

(Salts  of  Lemon  or 
Son  el). 


(^)  Prussic  Acid 

(Hydrocyanic  Acid, 
Scheele's  Acid),  this 
may  also  occur  in  oil 
of  almonds,  almond 
flavor,  peach  kernels, 
bitter  almond  water, 
laurel  water,  and 
cyanide  of  potassium. 


Their  Symptoms. 


With  the  above 
symptoms  there  is  the 
voidance  of  greenish 
or  black  urine,  and 
the  odor  of  the  acid 
can  be  detected  in 
the  breath. 


Burning  pain  in 
the  stomach,  cramp 
in  the  legs,  vomiting 
of  dark  colored  fluid, 
a  hacking  cough  with 
a  feeling  of  constric- 
tion in  the  throat,  the 
mouth  is  white  and 
sore,  there  is  great 
shock,  and  death  may 
rapidly  supervene. 

The  patient  almost 
immediately  after 
swallowing  the  acid 
becomes  insensible, 
with  fixed  and  glis- 
tening eyes,  the  pu- 
pils are  dilated  and 
insensitive  to  light, 
the  limbs  are  flaccid, 
the  skin  is  cold  and 
covered  with  a  clam- 
my perspiration,  the 
respirations  are  gasp- 
ing,   and     occur     at 


Their  General  Treatment. 


Administer  Epsom 
salts,  y^  oz.  in  8  ozs. 
of  warm  water,  then 
white  of  egg  mixed 
with  water  in  large 
quantities,  or  large 
quantities  of  milk,  or 
olive  oil>  2  to  4  ozs. 
in  I  pint  of  water,  or 
castor  oil,  i  oz. ;  also 
give  stimulants  freely 
and  apply  warmth  to 
the  extremities. 

Avoid  giving  pot- 
ash, soda^  or  ammo- 
nia, or  their  carbon- 
ates, but  administer 
frequently  chalk  and 
water,  magnesia  and 
water,  and  lime  wa- 
ter, and  then  give  i 
oz.  of  castor  oil,  and 
stimulants  freely. 

Administer  emetics 
first,  then  stimulants 
freely  and  ad  lib., 
and  if  necessary  by 
an  enema  ;  make  the 
patient  smell  the 
fumes  of  ammonia, 
apply  the  hot  and 
cold  douche  alter- 
nately, perform  arti- 
ficial respiration 
(about  20  to  the  min- 
ute), and  keep  it  up 
steadily,  and    at   the 


J'Ol^ONS  AND  THEIR  IMMEDIATE  TREATMENT    179 


Special  Poisons. 


2.     Aconite 

(Monkshood.  Blue 
Rocket)  and  its  al- 
kaloids ;  occurs  in 
aconite  U  n  i  m  e  n  t, 
neuialine,  etc. 


long  intervals,  and 
there  may  be  convul- 
sions. 


Their  Symptoms. 


There  is  warmth 
the  pit  of  the 
stomach,  tingling  of 
the  mouth,  lips  and 
tongue,  a  feeling  of 
constriction  in  the 
throat,  difficulty  in 
swallowing,  numb- 
ness of  the  tips  of  the 
fingers,  loss  of  sensa- 
tion, deafness  and 
dimness  of  sight ;  this 
is  followed  by  paraly- 
sis, first  of  th5  lower 
and  then  of  the  upper 
extremities,  the  pulse 
is  irregular  and  al- 
most imperceptible, 
the  respirations  are 
shallow,  feeble  and 
infrequent,  there  may 
be  convulsions,  the 
pupils  are  generally 
dilated,  there  is  great 
prostration,  and  death 
may  take  place  quite 
suddenly  after  some 
slight  exertion. 


Their  General  Treatment. 


same  time  use  fric- 
tion to  the  extremi- 
ties. 

Note. — If  life  can 
be  maintained  (or 
about  half  an  hour, 
recovery  is  almost 
certain. 


Give  emetics  first, 
then  stimulants  free- 
ly, apply  warmth  to 
the  lower  extremities, 
by  hot  water  bottles 
and  by  friction  with 
the  warm  hand.  Ap- 
ply a  mustard  poul- 
tice or  a  mustard  leaf 
over  the  heart,  keep 
the  patient  strictly  in 
the  recumbent  posi- 
tion and  perform  ar- 
tificial respiration  if 
necessary. 

Note. — Stimulants 
may  have  to  be  given 
by  an  enema. 


180 


FIRST  AID    TO    THE  INJURED 


Special  Poisons. 

3.  Alcohol,  as  in 
rectified,  proof,  and 
methylated  spirit, 
brandy,  rum,  whis- 
key, gin,  etc. 


4.  The  Alkalies, 

the  strong  caustic 
ones,  viz. : — 

(I)  Ammonia 
(Spirits  of  harts- 
horn, etc.),  as  in 
caustic  ammonia, 
ammonia  liniment, 
compound  cam- 
phor liniment, 
liquid  ammonia. 

(II)  Lime,  as 
caustic  lime,  quick- 
lime. 

(III)  Potash,  as 
caustic  potash. 

(IV)  Soda,  as 
caustic  soda. 


Their  Symptoms. 

Giddiness,  inabil- 
ity to  stand  or  walk, 
the  gait  is  tottering, 
the  expression  is  va- 
cant, the  face  is 
flushed,  the  conjunc- 
tivae are  congested, 
the  lips  are  livid,  the 
breath  smells  of  al- 
cohol, the  skin  is  cov- 
ered with  sweat,  the 
pupils  are  dilated  and 
fixed  but  may  be 
contracted,  c  o  n  v  u  1- 
sions  occur  and  are 
followed  by  stupor 
and  coma. 


Immediate  bu  r  n- 
ing  pain  in  the 
mouth,  throat  and 
stomach,  vomiting 
and  purging,  the 
mucous  membrane 
of  the  mouth  is  des- 
troyed, and  there  are 
symptoms  of  suffoca- 
tion and  of  great 
shock. 


Their  General  Treatment 


Give  emetics;  if 
the  patient  is  insen- 
sible rouse  him  and 
keep  him  awake,  ad- 
minister hot  strong 
coffee,  apply  the  hot 
and  cold  douche  al- 
ternately ;  when  the 
patient  has  sufficient- 
ly recovered,  wrap 
him  up  in  warm 
blankets  and  put  him 
to  bed. 


Caution. —  Eviet- 
ics  are  not  to  be 
give??,  but  administer 
vinegar,  lemon  o  r 
orange  juice,  tartaric 
or  citric  acid  in 
plenty  of  water  ;  give 
demulcents  and  stmi- 
ulants  if  required  ;  if 
the  power  of  swallow- 
ing is  lost,  give  in- 
halations of  acetic 
acid  or  vinegar  from 
a  pocket  handker- 
chief. 


POISONS  AND  THEIR  I3I3IEDIATE  TEEAT3IENT    181 


Special  Poisons. 


5.    Antimony, 

as  chloride  or  tartar- 
ated  antimony  (tartar 
emetic),  occurs  also 
in  antimonial  wine, 
and  in  Hooper's  or 
Hall's  specific. 


6.  Arsenic  (Ar- 
senious  acid,  White 
arsenic),  may  also  oc- 
cur in  Aqua  Tofania, 
fly  papers,  mineral, 
Vienna  and  Scheele's 
emerald  green.  Fow- 
ler's solution,  Simp- 
son's rat  paste.  Roth 
and  Ringeisen's  ver- 
min killer,  "  Rough 
on  Rats,"  cheap 
ice  creams,  crayons, 
French  chalks,  wall 
papers,  and  canned 
fruits  (as  an  impurity 
of  the  tin). 


Their  Symptoms. 


There  is  a  metallic 
taste  in  the  mouth, 
with  nausea  and  in- 
cessant vomiting,  a 
feeling  of  heat,  con- 
striction and  choking 
in  the  throat,  pain  in 
the  stomach,  violent 
purging,  and  cramps 
in  the  limbs,  the  skin 
is  cold,  the  head  and 
face  are  congested, 
and  there  is  great 
depression  and  col- 
lapse. 


Faintness  and  de- 
pression followed  by 
a  burning  pain  in  the 
stomach,  vomiting  of 
brown  matter  mixed 
with  mucus  and 
streaks  of  blood, 
purging,  severe 
cramps  in  the  calves 
of  the  legs,  constric- 
tion and  dryness  of  ; 
the  throat,  great  \ 
thirst,  hiccough,  loss 
of  voice,  cold  sweats, 
profound  shock  and 
exhaustion. 


Their  General  Treatment. 

Encourage  vomit- 
ing by  giving  large 
draughts  of  tepid 
water,  when  the  vom- 
iting subsides  admin- 
ister strong  tea  or 
coffee,  also  white  of 
egg  mixed  in  water, 
barley  water,  arrow- 
root or  milk.  Give 
stimulants  if  there  is 
collapse.  Wrap  the 
patient  up  in  warm 
blankets  and  put  hot 
water  bottles  to  his 
feet. 

Give  emetics,  and 
then  large  draughts 
of  tepid  greasy  or 
soapy  water,  or  salt 
and  water,  dialysed 
iron  in  I  oz.  doses,  or 
magnesia  in  large 
quantities,  these  are 
to  be  frequently  re- 
peated ;  give  olive  oil 
j4  pint  in  I  pint  of 
lime  water,  adminis- 
ter demulcents;  if 
there  is  depression, 
give  stimulants  free- 
ly, and  apply  warmth 
and  friction  ;  after  the 
acute  symptoms  have 
passed  off,  apply  lin- 
seed meal  poultices 
to  the  abdomen. 


182 


FIRST  AID   TO   THE  INJURED 


Special  Poisons. 


7.   Belladonna 

(the  Deadly  Night- 
shade) and  its  alka- 
loid atropine. 


Their  Symptoms. 


8.  Oantharides 

(Spanish  Fly,  Blister 
Beetle),  occurs  also 
in  blistering  fluid. 


Heat  and  dryness 
of  the  mouth  and 
throat,  suppression  of 
saliva,  difficulty  of 
swallowing  and  great 
thirst,  the  face  is 
flushed,  the  eyes  are 
prominent  and  spark- 
ling, the  vision  is 
double  or  indistinct, 
the  pupils  are  dilated 
and  insensible  t  o 
light,  there  is  great 
excitement  and  noisy 
delirium,  the  gait  is 
unsteady  and  stagger- 
ing, there  is  a  fre- 
quent desire  to  pass 
water,  with  inability 
to  do  so,  the  skin  is 
dry  and  there  may  be 
a  rash  like  that  of 
scarlet  fever. 

Burning  sensation 
in  the  throat  and 
stomach,  with  pain 
and  difficulty  in  swal- 
lowing, vomiting  of 
mucus  and  blood,  di- 
arrhoea with  blood 
and  slime  in  the  mo- 
tions, incessant  desire 
to  pass  water,  high 
temperature,  quick 
pulse,  headache,  loss 
of  sensibility,  and 
convulsions. 


Their  General  Treatment. 


Give  emetics  first, 
then  strong  hot  coffee 
and  stimulants,  apply 
mustard  to  the  calves 
of  the  legs  and  hot 
water  bottles  to  the 
feet,  administer  the 
hot  and  cold  douclie 
alternately,  and  per- 
form artificial  respira- 
tion. 


Give  emetics  and 
then  demulcents,  es- 
pecially white  of  egg 
and  milk  or  thick 
gruel,  but  avoid  giv- 
ing fats  and  oils  ; 
when  the  acute  symjv 
toms  have  been  re- 
lieved, give  the  pa- 
tient a  hot  bath  or 
apply  hot  linseed 
meal  poultices  to  the 
abdomen. 


POISONS  AND  THEIR  IMMEDIATE  TREATMENT    18c 


Special  Poisons. 


9.  Camphor,  as 
in  the  essence,  lini- 
ment and  spirits  of 
camphor,  and  in  Ru- 
bini's  solution. 


10.  Caustic  Lu- 
nar (Nitrate  of  sil 
ver). 


II.    Chloral 

(Chloral  hydrate, 
Syrup  of  chloral, 
Hunter's  chloral). 


12.  Chlorine 

Gas,  as  in  chloride 
of  lime. 


13-  Chloroform 

(inhaled). 


Their  Symptoms. 


Odor  of  the  breath, 
langour,  g  i  d  d  i  ness, 
faintness,  disturbance 
of  vision,  noises  in 
the  ears,  delirium  and 
convulsions,  a  cold 
and  clammy  skin, 
weak  pulse  and  diffi- 
cult breathing. 

Pain  and  discolora- 
tion of  the  mouth  and 
throat,  followed  by 
vomiting  of  whitish 
flakey  matter  which 
turns  black. 

Deep  sleep,  with 
loss  of  muscular 
power,  diminished 
sensibility;  the  face  is 
livid  and  bloated,  the 
pulse  is  slow  or  very 
weak,  the  respirations 
are  dirfiinished,  and 
the  surface  of  the 
body  is  cold. 


Irritation  of  the 
throat,  cough,  tight- 
ness of  the  chest, 
difficulty  of  breath- 
ing and  inability  to 
swallow. 

The  respirations 
are  arrested,  the 
breathing   is   stertor- 


Their  General  Treatment. 


Give  emetics  and 
then  stimulants  free- 
ly, apply  warmth  to 
the  extremities  and 
administer  the  hot 
and  cold  douche  al- 
ternately. 


Give  common  salt 
dissolved  in  water  or 
milk  freely,  give 
emetics  (but  not  sul- 
phate of  zinc),  and 
demulcents. 

Give  emetics,  wrap 
the  patient  up  in 
warm  blankets,  and 
apply  hot  water  bot- 
tles to  the  feet,  keep 
the  patient  roused  by 
shouting  or  flapping 
his  face  with  a  wet 
towel,  give  hot  strong 
coffee,  and  perform 
artificial  respiration 
if  there  is  the  slight- 
est failure  of  the 
breathing. 

Admit  plenty  of 
fresh  air,  give  inhala- 
tions of  steam  or  of 
very  dilute  ammonia. 


Pull  the  tongue 
forward,  see  that  the 
mouth  and  throat  are 


184 


FIRST  AID    TO    THE  INJURED 


Special  Poisons. 


1 4.  Chloroform 

(swallowed). 


Their  Symptoms. 


ous,  and   the   face  is 
livid. 


15.    Copper,   i--  j 

l1ie  sulphate  (blue 
vilriol,  blue  stone),  or 
the  acetate  (verdi- 
gris). 


The  breath  smells 
of  chloroform,  the 
gait  is  staggering, 
this  is  followed  by 
insensibility,  the  pu- 
pils are  dilated,  the 
breathing  is  stertor- 
ous, the  skin  is  cold, 
and  the  pulse  is  im- 
perceptible. 

There  is  a  metallic 
taste  in  the  mouth, 
constriction  in  the 
throat  and  gullet, 
griping  and  colicky 
pains  in  the  abdomen, 
nausea,  vomiting  and 
purging,  difficult 
breathing,  (juick 
pulse,  great  weakness 
and  thirst,  cold  per- 
spiration, coldness  of 
the  limbs,  headache, 
giddiness,  and  finally 
coma. 


Their  General  Treatment. 


clear,  loosen  every- 
thing tight  about  the 
chest,  fla]^  the  face 
and  chest  with  a  wet 
towel,  give  plenty  of 
fresh  air,  ajijily  the 
hot  and  cold  douche 
alternately  to  the 
chest  and  head,  and 
perform  artificial  res- 
piration. 

Give  emetics  first, 
then  carbonate  of 
soda  dissolved  in 
plenty  of  water,  rouse 
the  patient  in  every 
possible  way,  api)ly 
mustard  to  the  calves 
of  the  legs  and  a 
mustard  leaf  over  the 
heart. 

P'irst  give  laige 
quantities  of  m  i  1  k 
and  eggs,  then  emet- 
ics (if  there  is  no 
vomiting),  and  then 
large  draughts  of 
tepid  water,  after 
that  barley  water,  ar- 
rowroot or  gruel,  and 
apply  hot  linseed 
meal  poultices  to  the 
abdomen. 


rOISONS  AND  THEIR  IMMEDIATE  TREATMENT    185 


Special  Puisons. 

;6.  Oroton  Oil. 


17.  Ergot  of  Rye 

aiul    its  alkaloitls,  er- 
gulinc,  etc. 


1 8.  Ether  (in- 
haled). 

19-  Fungi  (Fly 
fungus,  poisonous 
mushrooms). 


20.  The  Gases, 

viz.,  carbonic  acid  or 
carbonic  oxide  gas, 
coal  gas  or  sewer 
gas,  choke  damp  or 
after  damp,  marsh 
gas,  charcoal  fumes, 
and  acetylene. 


Their  Symptoms. 

Great  pain  in  the 
abdomen,  with  vom- 
iting and  purging,  the 
face  is  pale,  the  fea- 
tures are  pinched, 
the  pulse  is  small,  the 
skin  is  moist,  and 
there  is  great  col- 
lapse. 

Tingling  and  cramp 
of  the  limbs,  dizzi- 
ness, weakness,  itch- 
ing, vomiting  and 
diarrhoea. 


Same  as  chloroform 
inhaled. 

There  is  violent 
colic,  with  vomiting 
and  diarrhrea,  great 
excitement  and  then 
coma,  the  pulse  is 
slow,  the  breathing  is 
stertorous,  the  pupils 
are  dilated,  and  the 
extremities  are  cold. 

There  is  irritation 
of  the  throat,  witli 
headaclie,drowsincss, 
giddiness,  and  sing- 
ing in  the  ears,  loss 
of  muscular  power, 
lividity,  hurried  res- 
pirations and  coma. 


Their  General  Treatment. 


Give  emetics  first, 
then  demulcents,  es- 
pecially white  of  egg 
in  milk,  and  stinm- 
lants  freely,  and  ap- 
ply hot  linseed  meal 
poultices  to  the  ab- 
domen. 

Give  emetics  first, 
then  castor  oil,  after 
that  strong  tea  and 
stimulants,  keep  the 
patient  in  a  recum- 
bent position,  and  ap- 
ply warmth  to  the 
extremities. 

Same  as  chloroform 
inhaled. 

Give  emetics  first, 
then  castor  oil,  I  oz., 
then  stimulants  free- 
ly, apply  warmth  to 
the  extremities  and 
hot  linseed  meal  poul- 
tices to  the  abdomen. 


Remove  quickly  to 
the  fresh  air,  and  per- 
form artificial  respira- 
tion, ajiply  smelling 
salts  to  the  nostrils, 
and  cold  to  the  head 
and  chest,  and  give 
stimulants. 


186 


FIRST  AID    TO    THE  INJURED 


Special  Poisons. 


Their  Symptoms. 


21.  Holly  Ber- 
ries. 


22.  HyoBcya- 

mus  (henbane),  and 
its  alkaloids  hyoscya- 
mine,  etc. 


23.    Iodine    and 
Iodoform. 


24.    Laburnum 

and  its  active  princi- 
ple cytisine,  which  is 
also  present  in  Arnica 


25.  LEAD  as  ace- 
tate (sugar  of  lead), 
lead  paint  or  white 
lead ;  may  occur  in 
crayons,French  chalk 
and  hair  dyes. 


There  is  vomiting, 
with  pain  in  the  head 
and  abdomen,  and 
purging,  the  pupilh^ 
are  contracted,  then 
drowsiness  followed 
b  y  unconsciousness 
and  collapse. 

Much  the  same  as 
belladonna,  z>.,thirst, 
dilated  pupils,  delir- 
ium, etc. 

There  is  pain  and 
heat  in  the  throat  and 
stomach,  with  vomit- 
ing and  purging  (the 
vomited  matter  may 
be  yellow  or  blue), 
follow  ed  by  giddiness 
and  faintness  with 
convulsive  move- 
ments. 

There  is  purging, 
vomiting,  and  great 
restlessness,  this  is 
followed  by  drowsi- 
ness, insensibility  and 
convulsive  twitchings 

There  is  dryness  of 
the  throat,  with  a 
metallic  taste  and 
great  thirst,  colicky 
pains  in  the  abdomen 
which  are  relieved  by 


Their  General  Treatment. 


Give  emetics,  and 
then  stimulants  free- 
ly, apply  friction  and 
warmth  to  the  ex- 
tremities. 


Give  emetics  first, 
then  stimulants  mod- 
erately, and  apply 
the  hot  and  cold 
douche  alternately. 

Give  emetics  first, 
then  starch  and  wa- 
ter, or  gruel  and  wa- 
ter, or  white  of  eggs 
and  water  freely. 


Give  emetics  first, 
then  stimulants  in 
moderation,  and  ad- 
minister the  hot  and 
cold  douche  alter- 
nately  to  the  bend 
and  chest. 

Give  emetics  free- 
ly, then  Epsom  salts 
{]4  oz.  in  a  tumbk  r 
of  warm  water),  th.en 
demulcents,  and  ap- 
ply hot  linseed  meal 


POJiSONS  AND  THEIR  IMMEDIATE  TREATMENT    187 


Special  Poisons. 


26.  MERCURY, 

as  corrosive  sublim- 
ate, perchloride  of 
mercury,  red  and 
white  percipitate,  red 
oxide  of  mercury,  and 
the  acid  nitrate  of 
mercury. 


27.  Mussels,  also 
Ptomaines  (ani- 
mal alkaloids,  poison- 
ous meat,  poisonous 
fish). 


Their  Symptoms. 


pressure,  c  o  n  s  t  ip  a- 
tion,  cramps  in  the 
legs,  cold  sweats,  pa- 
ralysis of  the  lower 
extremities,  and  con- 
vulsions. 

If  corrosive  s  u  b- 
limate  or  the  acid 
nitrate  is  taken,  the 
lips  and  mouth  are 
white  and  swollen, 
the  tongue  is  white 
and  shrivelled,  and 
there  is  a  sense  of 
constriction  in  the 
throat ;  in  all  cases 
of  poisoning  by  mer- 
cury there  is  a  metal- 
lic taste  in  the  mouth, 
pain  in  the  stomach, 
nausea,  vomiting  of 
stringy  mucus  mixed 
with  blood,  profuse 
purging  with  bloody 
stools,  a  cold  and 
clammy  skin,  difficult 
respirations,  syncope 
and  convulsions. 

There  is  uneasiness 
and  weight  at  the  pit 
of  the  stomach,  a  sen- 
sation of  numbness  in 
the  extremities,  heat, 
dryness  and  constric- 
tion in  the  throat, 
thirst,  shivering,  dif- 
ficulty of  breathing, 
cramps    in    the    legs, 


Their  General  Treatment. 


poultices  to  the  abdo- 
men. 


First  give  white  of 
egg  mixed  with  wa- 
ter or  flour  and  wa- 
ter, then  give  emetics 
freely,  after  this  de- 
mulcents and  stimu- 
lants. 


Give  emetics  first, 
then  castor  oil  i  oz., 
than  stimulants  free- 
ly, apply  hot  water 
bottles  to  the  feet, 
and  wrap  the  patient 
up  in  warm  blankets. 


188 


FIRST  AID    TO    THE  INJURED 


Special  Poisons. 


28.  Nitrous  Ox- 
ide Gas  (laughing 
gas). 

29.  Nitro-Ben= 
ZOl  (nitro-benzine, 
artificial  oil  of  bitter 
almonds,  essence  of 
henbane).  Also  pres- 
ent in  aniline  dyes, 
liqueurs,  sweetmeats, 
pomades. 

30.  NUX  VOM- 
ICA (St.  Ignatius 
Bean),  and  its  alka- 
loid STRYCH- 
NIA (as  in  vermin 
killers). 


Their  Symptoms. 


31.  OPIUM  (lau- 
danum), and  Us  alka- 
loids (morphine,  co- 
deine, etc.),  occur  in 
tincture  and  wine  of 
opium,  Battley's  sed- 
ative  solution,  Black 


inflammation  of  the 
eyes,  colic,  vomiting 
and  purging,  itching 
of  the  skin,  failure 
of  the  heart's  action 
and  collapse 

Same  as  chlorofoi  m 
inhaled. 

There  is  weakness 
and  discomfort,  great 
nausea  and  anxiety, 
confusion  of  the 
mind,  lividity  of  the 
face  and  body,  dilated 
pupils  and  convul- 
sions. 

Violent  rigid  con- 
vulsions, with  lock- 
jaw during  the  con- 
vulsive attack  ;  the 
eyeballs  are  promi- 
nent, the  pupils  di- 
lated, the  respirations 
impeded,  and  the 
pulse  feeble  and  very 
rapid.  Death  usually 
takes  place  either 
from  asphyxia  or 
from  collapse  during 
a  paroxysm. 

Mental  excitement, 
followed  by  h  e  a  d- 
ache,  uneasiness,  a 
sensation  of  weight 
in  the  limbs,  inca- 
pacity for  exertion, 
sleepiness,diminution 


Their  General  Treatment. 


Same  as  chloroform 
inhaled. 

Give  emetics  first, 
then  stimulants  free- 
ly, apply  the  hot  and 
cold  douche  alter- 
nately, and  perform 
artificial  respiration. 


Give  emetics  first, 
then  animal  charcoal 
ad  lib.  mixed  in  wa- 
ter, followed  by  an 
emetic;  if  possible 
perform  artificial  res- 
piration. 


Give  emetics  first, 
rouse  and  keep  the 
patient  awake  in 
every  possible  way, 
by  making  him  walk 
about,  or  slapping 
him  with  a  wet  towel, 


POISONS  AND  THEIR  HI  MEDIATE  TREATMENT    189 


Special  Poisons. 


Drops,  Chloiodyne, 
Dalby's  Ccilminative, 
Godfrey's  Cordial 
and  Elixir,  Mother's 
Friend  and  Soothing 
Syrup,  Nepenthe, 
Syrup  of  Poppies, 
Paregoric  and  Dover 
Powder. 


32.  Paraffin  Oil. 


33.  PHOSPHOR 

US  (as  in  matches, 
phosphorus  paste,  rat 
poison,  vermin  killer, 


Their  Symptoms. 


of  sensibility,and  con- 
traction of  the  pupils ; 
at  first  the  patient 
can  be  roused  with 
difficulty,  but  later  on 
he  becomes  quite  in- 
sensible, his  muscles 
are  relaxed,  his  skin 
is  cold,  the  pupils  fail 
to  respond  to  light, 
his  face  and  lips  are 
cold  and  blue,  the 
respirations  are  slow, 
irregular,  and  stertor- 
ous, and  the  pulse  is 
weak  and  compressi- 
ble. 


The  symptoms 
vary  very  much,  there 
may  be  a  burning 
sensation  in  the 
mouth,  gullet  or 
stomach,  and  great 
thirst ;  the  extremi- 
ties are  cold,  the  face 
is  pale,  the  pulse  is 
feeble,  the  respira- 
tions are  weak,  and 
often  there  is  coma. 

Pain  in  the  stom- 
ach, vomiting,  the 
vomited  matter  may 
be    luminous    in    the 


Their  General  Treatment. 

apply  ammonia  or  sal 
volatile  to  the  nos- 
trils, give  a  pint  of 
hot  strong  coffee,  ap- 
ply the  cold  douche 
to  the  head  frequent- 
ly, perform  artificial 
respiration  and  keep 
it  up  at  least  for  two 
hours.  Do  not  give 
wine  or  brandy. 

C  A  u  T  I  o  N. — I  n 
making  the  patient 
walk  about  be  care- 
ful not  to  over-ex- 
haust him,  as  with 
opium  poisoning 
there  is  always  a  cer- 
tain amount  of  de- 
pression. 

Give  emetics  first, 
then  stimulants  free- 
ly, and  apply  warmth 
to  the  body. 


Give  emetics  first, 
then  Epsom  salts  (^ 
oz.  in  a  tumbler  of 
water),  stimulants  if 


190 


FIRST  AID   TO   THE  INJURED 


Special  Poisons. 

rat  paste,  Roth  & 
R  i  n  g  e  i  s  e  n's,  with 
arsenic). 


34.    Tin    and    its 

salts. 


35.  Tobacco  and 

its  alkaloid,  nicotine. 


36.  Turpentine 

(oil  and  spirits  of 
turpentine,  turps, 
camphene). 


37.  Zinc,  as  sul- 
phate (white  vitriol), 
and    chloride    (Bur- 


Their  Symptoms. 


dark,  odor  of  phos- 
phorus in  the  breath, 
bleeding  from  the 
nose,  blood  stained 
motions,  and  convul- 
sions. 

The    same    as    in 
lead  poisoning. 


Nausea  and  vomit- 
ing, accompan  ied 
with  great  weakness 
and  faintness,  con- 
fusion of  ideas,  dim- 
ness of  sight,  weak 
pulse,  cold  skin,  cov- 
ered with  clammy 
perspiration,  pupils 
at  first  contracted  and 
then  dilated. 

Odor  in  the  breath, 
intoxication,  pupils 
contracted,  breathing 
stertorous,  coma,  col- 
lapse and  tetanic  con- 
vulsions, irritability 
of  the  bladder,  the 
urine  having  the 
smell  of  violets.  The 
symptoms  of  turpen- 
tine poisoning  resem- 
ble somewhat  those 
of  opium. 

Corrosion  of  the 
lips  and  of  the  mu- 
cous membrane  of  the 


Their  General  Treatment- 


required,  and  demul- 
cents, especially  milk. 
Avoid    giving   fats 
and  oils. 


Give  emetics  first, 
then  sal  volatile  in 
water,  and  white  of 
egg  in  milk. 

Give  emetics  first, 
then  strong  tea,  and 
stimulants  freely,  ap- 
ply warmth  to  the 
extremities  and  keep 
the  patient  in  a  re- 
cumbent position. 


Give  emetics  first, 
then  Epsom  salts  ( i 
oz.  in  a  half  a  tumbler 
of  warm  water),  and 
demulcents. 


Do  not  give  emetics 
but  give  first  large 
draughts  of  milk  and 


FOJSONS  AND  THEIR  IMMEDIATE  TREATMENT    191 


Special  Poisons. 

1  e  t  t's    Disinfecting 
i'luid^. 


Their  Symptoms. 


mouth,  pain  and  in- 
cessant vomiting,  the 
pulse  and  respira- 
tions are  quickened, 
the  pupils  are  dilated, 
the  muscles  are  par- 
alyzed, and  coma 
supervenes. 


Their  General  Treatment. 

white  of  egg,  and 
then  bicarbonate  of 
soda  or  common  soda 
in  large  quantities  dis- 
solved in  warm  wa- 
ter, and  ihen  strong 
tea,  apply  linseed 
meal  poultices  to  the 
abdomen. 


Note. — The  following  Poisons  are  frequently  taken  either  acci- 
dentally or  for  suicidal  purposes,  viz.  :  Carbolic  acid,  Oxalic  acid, 
Prussic  acid,  Arsenic,  Opium,  Phosphorus,  Strychnia  (Nux  vomica), 
Lead  (Sugar  of)  and  Mercury  (Red  and  White  Precipitate),  In 
the  foregoing  table  these  are  printed  in  heavy  capitals. 


CHAPTEK  yill 

THE  IMMEDIATE  TKEATMENT  OF  INSENSIBILITY 
AND  FITS 

Insensibility,  its  causes— Fits,  kinds  of— The  Causes,  Symp- 
toms and  Treatment  of  Syncope,  Shock,  Concussion  and 
Compression  of  the  Brain.  Apoplexy,  Alcoholic  Intoxica- 
tion, Sunstroke  and  Freezing — Test  for  Insensibility — How 
to  act  if  a  patient  is  found  in  a  state  of  Unconsciousness — 
The  Symptoms  and  Treatment  of  Epileptic  Fits,  Hysterical 
Fits  and  the  Convulsions  of  Infants. 

INSENSIBILITY 

Loss  of  consciousness  may  be  produced  by  the 
following  causes : — 

1.  Syncope,  or  fainting. 

2.  Asphyxia,  or  suffocation. 

3.  Shock  and  collapse. 

4.  Concussion  of  the  brain. 

5.  Compression  of  the  brain. 

6.  Apoplexy. 

7.  Alcoholic  intoxication. 

8.  Narcotic  poisoning,  as  opium  poisoning. 

192 


ni MEDIA  TE  TREA  TMENT  OF  INSENSIBILITY     1 9:5 

9.     (Sunstroke. 
10.     Freezing. 

Unconsciousness  is  also  present  in  the  follow- 
ing :— 

1.  Epilepsy. 

2.  The  convulsions  of  infants. 

3.  Uraemic  poisoning,  which  often  comes  on 
in  the  course  of  kidney  disease  and  is  due  to  the 
non-excretion  (by  the  kidneys)  of  the  waste  ma- 
terial in  the  blood. 

But  as  convulsions  form  the  most  prominent 
symptom,  these  diseases  are  dealt  with  separately 
under  ''  Fits." 

I.  Syncope,  or  Fainting,  may  be  due  to  men- 
tal emotion,  pain,  extreme  exhaustion  (as  from 
hunger,  fatigue,  etc.),  haemorrhage,  cold,  heat 
(particularly  if  combined  with  a  close  atmos- 
phere, as  in  heated  rooms,  in  large  crowds,  etc.), 
constriction  of  the  chest  (as  in  tight  lacing,  etc.), 
and  organic  disease  of  the  heart. 

Symjjtoms. — Fainting  is  generally  ushered  in 
by  a  feeling  of  giddiness  and  fluttering  at  the 
heart.  This  is  followed  by  the  face  becoming 
suddenly  pale  and  the  lips  white ;  the  pulse  be- 
comes weakened  and  the  breathing  quickened  ;  a 
cold  sweat  appears  on  the  brow^  and  the  palms 


194  FIRST  AID    TO    THE  INJURED 

of  the  hands  ;  the  patient  staggers  and  finally 
falls  to  the  ground  in  an  unconscious  state. 
Rarely  convulsive  movements  of  the  whole  body 
may  also  be  present. 

Treatment. — As  fainting  is  caused  by  a  dim- 
inution of  the  supply  of  blood  to  the  brain  from 
partial  paralysis  of  the  heart,  the  object  to  be 
aimed  at  in  treatment  is  to  restore  the  cerebral 
circulation  ;  therefore,  when  a  person  has  fainted, 
do  not  attempt  to  place  him  in  a  sitting  or  stand- 
ing posture  (as  this  will  only  embarrass  the  al- 
ready weakened  action  of  the  heart,  and  may  be 
fatal),  but  lay  him  flat  on  his  back,  or,  better 
still,  on  his  left  side  with  his  pelvis  and  feet 
slightly  raised  ;  loosen  all  tight  clothing  about 
his  body  and  neck ;  give  him  plenty  of  fresh  air ; 
sprinkle  cold  water  on  his  face  ;  apply  smelling 
salts  to  his  nostrils  ;  when  able  to  swallow,  give 
him  a  glass  of  water  or  a  little  brandy,  whiskey, 
or  sal  volatile  mixed  in  water,  and  keep  him  in 
the  recumbent  position  for  some  time  after  he 
has  recovered.  If  the  faint  is  prolonged  and 
consciousness  does  not  return,  send  for  medical 
assistance,  but  in  the  meanwhile  apply  warmth 
to  the  feet  and  a  hot  mustard  plaster  over  the 
region  of  the  heart,  and  if  natural  breathing  has 


IMMEDIATE  TREATMENT  OF  INSENSIBILITY    195 

not   returned,   perforin   artificial  respiration  by 
the  "  Sylvester  '•  method. 

In  a  crowded  room  a  fainting  fit  may  be  pre- 
vented by  placing  the  patient  in  a  stooping  posi- 
tion on  a  chair  and  bending  his  head  between  his 
knees.  The  person  must  be  held,  for  if  he  faints 
in  this  position  he  dives  forward  on  to  his  head, 
and  may  turn  a  somersault  or  might  break  his 
neck.  If  the  patient  has  completely  fainted  this 
treatment  is  not  to  be  attempted,  as  it  only  helps 
to  obstruct  the  circulation  and  respiration. 

2.  Asphyxia. — This  has  been  dealt  with  in 
Chapter  lY. 

3.  Shock,  or  Collapse,  may  be  produced  by 
severe  injuries  or  emotional  disturbance,  causing 
a  profound  depressing  effect  upon  the  central 
nervous  system. 

The  injuries  most  liable  to  produce  shock 
are  : — 

(I)  Those  involving  large  surfaces  of  the  skin, 
as  in  burns  and  scalds. 

(II)  Those  causing  crushing  or  tearing  of  the 
body,  as  machinery  and  railway  accidents. 

(III)  Those  affecting  the  abdomen  and  viscera. 
Loss  of  blood  and  exposure  to  cold  intensify 

the  condition  of  shock. 


190  FIRST  AID   TO   THE  INJURED 

Symptorns. — A  person  in  a  state  of  shock  pre- 
sents the  following  appearance  :  He  lies  flat  on 
his  back,  his  limbs  are  flaccid,  and  he  makes  no 
spontaneous  movements ;  his  body  is  cold  and 
clammy,  his  face  is  pale,  his  eyes  are  sunken,  his 
pulse  is  small,  feeble  and  irregular,  his  respira- 
tions are  shallow,  feeble  and  sighing,  his  temper- 
ature falls  to  97°  F.  or  a  degree  or  two  lower, 
and  he  is  semi-unconscious. 

Should  a  case  of  shock  tend  to  terminate  fa- 
vorably, the  condition  known  as  that  of  "  Reac- 
tion "  comes  on.  This  is  usually  ushered  in  by 
the  patient  vomiting,  the  pulse  then  becomes 
stronger,  the  body  warmer,  and  color  returns  to 
the  face. 

Treatment. — The  object  to  be  aimed  at  in 
treatment  is  to  bring  about  reaction  by  the  appli- 
cation of  warmth  and  the  administration  of  stim- 
ulants. Therefore,  to  treat  shock  place  the  pa- 
tient in  bed  between  blankets  as  soon  as  possible, 
keeping  his  head  quite  low.  Apply  hot  water 
bottles  to  his  feet  and  between  his  thighs,  and 
apply  friction  to  his  arms  and  legs. 

If  able  to  swallow,  give  him  small  quantities 
of  hot  stimulants,  and  frequently  repeat  them 
till  reaction  takes  place,  then  lessen  the  stimu' 


IMMEDIATE  TEEATMENT  OF  INSENSIBILITY    197 

lants  considerably,  taking  care  not  to  over  stimu- 
late. 

During  the  state  of  collapse,  should,  the  breath- 
ing become  embarrassed,  perform  artificial  res- 
piration according  to  the  "  Sylvester  "  method. 

4.  Concussion  of  the  Brain  is  caused  usually 
by  blows  or  falls  upon  the  head,  or  falls  upon  the 
feet  or  lower  end  of  the  spine,  the  effect  being  a 
severe  shaking  up  of  the  brain  substance. 

/Symptoms. — These  var}^  in  their  severity  ac- 
cording to  the  force  of  the  blow  applied.  The 
patient  may  present  the  appearance  of  being 
merely  stunned,  or  he  may  be  in  a  condition 
identical  with  that  already  described  under 
"  Shock." 

Treatment. — The  same  as  for  shock  ;  and  at 
the  same  time  apply  cold  in  the  form  of  ice  or 
wet  cloths  to  the  head.  Avoid  alcoholic  stimu- 
lants, but  give  instead  hot  beef  tea  or  hot  coffee, 
and  keep  the  patient  absolutely  quiet  in  a  dark- 
ened room. 

5.  Compression  of  the  Brain  is  caused  by  in- 
juries to  the  head  producing  pressure  of  the  brain 
substance  either  by  the  depression  of  a  piece  of 
bone  on  to  it,  or  by  a  blood  clot  (produced  by 
the  rupture  of  a  blood-vessel). 


198  FIRST  AID    TO   THE  INJURED 

Symptoms. — Kesemble  those  of  apoplexy,  which 
see. 

Treatment. — If  there  is  a  wound  on  the  head, 
dress  it;  otherwise  adopt  the  same  treatment  as 
for  apoplexy. 

6.  Apoplexy  is  caused  by  the  bursting  of  a 
diseased  blood-vessel  into  the  substance  of  or  upon 
the  surface  of  the  brain,  causing  compression  of 
that  organ.     It  usually  occurs  in  elderly  persons. 

Sy77iptoms. — Just  before  the  attack  there  are 
generally  some  premonitory  symptoms,  such  as 
headache,  giddiness  especially  on  stooping,  weight 
and  fulness  in  the  head,  noises  in  the  ears.  When 
the  actual  attack  occurs,  the  patient  is  more  or 
less  unconscious,  his  face  is  flushed,  his  breathing 
is  shallow  and  stertorous  ;  his  eyes  are  insensible 
to  light  and  touch,  the  pupils  are  fixed,  and  are 
either  unequally  dilated,  or  one  or  both  may  be 
contracted  ;  his  pulse  is  full  and  slow,  and  there 
is  paralysis  more  or  less  affecting  one  side  of  the 
body. 

Treatment. — The  object  of  treatment  is  to 
get  the  circulation  quiet  and  the  heart's  action  free 
from  embarrassment ;  therefore  loosen  all  tight 
clothing  about  the  neck  and  chest,  put  the  patient 
to  bed  with  his  head  raised,  and  apply  cold  to  it ; 


IMMEDIATE  TREAT3IENT  OF  INSENSIBILITY    199 

apply  hot  water  bottles  to  his  feet  and  mustard 
poultices  to  the  calves  of  his  legs.  Be  careful  to 
give  nothing  by  the  mouth  (as  it  may  choke  the 
patient),  and  send  for  medical  assistance. 

7.  Alcoholic  Intoxication  : — 

Symptoms. — A  person  in  a  state  of  stupor  from 
alcohol  presents  the  following  picture :  He  is 
semi-unconscious,  and  can  be  partially  roused,  his 
face  is  flushed  and  bloated,  his  eyes  are  reddened 
and  bloodshot  but  are  not  insensible  to  touch,  his 
pupils  are  equally  dilated  and  fixed,  his  lips  are 
livid,  his  breathing  is  slow,  the  surface  of  his 
body  is  cold,  and  he  may  smell  of  liquor. 

]}^ote. — Alcoholic  stupor  may  be  hard  to  dis- 
tinguish from  apoplexy,  but  the  state  of  the 
pupils,  the  sensitiveness  of  the  eyes  to  touch,  and 
the  presence  or  absence  of  paralysis  will  help  to 
determine  the  condition. 

Treatment.— (See  "Poisons,"  Chapter  VII, 
page  180.) 

Caution. — If  in  doubt  as  to  whether  a  person 
is  suff'ering  from  drunkenness  or  apoplexy,  treat 
him  for  the  latter  and  be  particularly  careful  not 
to  make  him  vomit. 

8.  Narcotic  Poisoning. — (See  "  Opium  Poison 
ing,"  Chapter  VII,  page  188.) 


200  FIRST  AID    TO    THE  INJURED 

9.  Sunstroke  is  caused  by  exposure  to  the  rays 
of  the  sun. 

Symj^toms. — Sunstroke  is  ushered  in  with  gid- 
diness, nausea  and  weakness;  this  is  followed  by 
drowsiness  and  more  or  less  unconsciousness. 
The  eyes  are  bloodshot,  the  skin  is  hot  and  dry, 
the  breathing  is  quick  and  noisy  ;  the  pupils  are 
contracted  at  first  and  become  dilated  afterward  ; 
the  pulse  may  be  slow  or  quick,  and  there  may 
be  convulsions. 

Treatment. — Place  the  patient  in  a  cool, 
shady  spot ;  remove  the  clothing  from  the  neck 
and  upper  part  of  the  body  and  raise  the  head  ; 
douche  the  head,  neck,  chest,  and  spine  with  cold 
water,  or  wrap  cold  sheets  round  him,  and  con- 
tinue these  cold  applications  till  he  becomes  con- 
scious, then  remove  him  to  bed,  keep  the  room 
darkened,  and  watch  him  carefully  ;  if  the  un- 
consciousness returns,  renew  the  application  of 
cold. 

10.  Freezing : — 

Treatment. — Take  the  patient  into  a  room 
which  has  no  fire  in  it,  rub  the  body  with 
ice-cold  or  snow  water  and  restore  warmth 
gradually. 

It  is  dangerous  to  apply  heat  too  early  ;  as  soon 


IMMEDIATE  TEEAT3IENT  OF  INSENSIBILITY    201 

as  the  patient  is  able  to  swallow  give  him  stimu- 
lants and  hot  drinks. 

Test  for  Insensibility. — To  determine  whether 
a  person  is  insensible,  raise  the  eyelid  and  touch 
the  white  of  the  eye,  blinking,  which  cannot  be 
avoided,  if  the  person  is  conscious,  does  not  occur. 

How  to  act  if  a  Patient  is  found  in  a  State  of 
Unconsciousness. — Before  efficient  help  can  be 
rendered,  the  first  thing  to  do,  is  to  try  and  arrive 
at  the  cause  which  has  produced  the  state  of  un- 
consciousness, and  in  order  to  do  this  a  sys- 
tematic examination  of  the  patient  and  his  sur- 
roundings must  be  made,  therefore  proceed  as 
follows  : — 

(I)  Notice  the  position  of  the  body  and  its 
surroundings. 

(U)  Notice  whether  the  body  is  lying  still  or 
there  are  convulsive  movements. 

(Ill)  If  possible  obtain  all  information  as  to 
the  cause. 

(lY)  Lay  the  patient  on  the  back,  inclining  the 
head  to  one  side  (to  prevent  the  tongue  from 
falling  back  or  vomited  matter  going  down  the 
trachea) ;  if  the  face  is  flushed  slightly  raise  the 
head,  if  the  face  is  pale  keep  the  head  flat,  place 
the  arms  by  the  sides  and  extend  the  legs,  and 


^02  FIK^T  AID    TO   THE  INJURED 

loosen  all  tight  clothing  about  the  neck  and 
chest. 

(Y)  Examine  the  head,  to  ascertain  whether 
there  is  a  depressed  wound  (which  would  suggest 
compression),  or  a  mere  bruising  (which  would 
suggest  stunning). 

(VI)  Examine  the  eyes  to  see  if  the}^  are  sen- 
sitive to  light  and  touch,  if  there  is  any  squint- 
ing, and  the  state  of  the  pupils ; 

{ci)  If  sensitive  to  touch,  no  brain  injuries  are 
present. 

{h)  If  the  pupils  are  unequally  contracted, 
there  is  brain  trouble. 

(c)  If  the  pupils  are  equally  contracted,  there 
is  opium  poisoning. 

(YII)     Examine  the  face  ; 

{a)  If  it  is  drawn  to  one  side,  this  will  indicate 
apoplexy  or  compression  of  the  brain. 

ih)  If  it  is  bloated  and  flushed,  this  will  sug- 
gest the  excessive  use  of  alcohoL 

(VIII)  Smell  the  breath  ;  the  odor  of  opium 
or  alcohol  may  be  detected. 

(IX)  Examine  the  mouth  and  tongue ;  froth  in 
the  mouth  and  a  tongue  that  has  been  bitten  will 
indicate  fits,  particularly  epileptic. 

(X)  Notice  the  breathing ; 


IMMEDIATE  TREATMENT  OF  INSENSIBILITY    203 

{a)  If  it  is  slow,  it  indicates  great  weakness 
as  in  shock. 

(h)  If  it  is  snoring  (stertorous),  it  indicates 
brain  trouble. 

(XI)  Examine  the  pulse  ; 

{a)     If  it  is  slow,  there  is  brain  trouble. 

(p)  If  it  is  rapid,  there  is  sunstroke  or 
fever. 

{c)  If  it  is  quick  and  thready,  there  is  great 
weakness — such  as  shock. 

(XII)  Feel  the  surface  of  the  body ; 

(«)  If  the  skin  is  abnormally  cold,  there  is 
either  freezing,  intoxication,  collapse,  or  faint- 
ing. 

ih)  If  the  skin  is  hot,  there  is  sunstroke  or 
high  fever. 

(XIII)  Examine  the  ribs,  collar  bones  and 
limbs  for  fractures. 

(XIY)  Examine  the  limbs  to  see  if  there  is 
any  paralysis;  this  is  done  by  raising  the  limbs 
and  allowing  them  to  fall,  if  they  do  so  lifelessly 
it  suggests  paralysis. 

(XY)  If  convulsive  movements  are  present, 
the  patient  is  subject  to  fits  of  some  kind  (either 
epileptic,  hysterical  or  ursemic  in  an  adult,  or 
convulsions  of  infants). 


204  FIRST  AID   TO    THE  INJURED 

FITS 

I.  Epileptic  Fits. — The  distinguishing  features 
of  these  fits  are  convulsive  movements  and  un- 
consciousness. An  epileptic  fit  begins  by  the  pa- 
tient suddenly  falling  unconscious,  with  strained 
and  rigid  muscles  ;  as  he  is  seized  he  may  utter  a 
sharp  shrill  cry  or  yell.  This  stage  of  rigidity  is 
then  succeeded  by  a  stage  of  convulsions  in 
which  the  patient's  body  is  thrown  into  violent 
tvvitchings  and  contortions  with  foaming  at  the 
mouth.  During  this  stage  the  tongue  may  be 
bitten.  After  the  patient  has  been  in  the  con- 
vulsive stage  for  a  few  minutes,  he  ma}^  at  once 
regain  his  consciousness  or  he  may  be  more  or 
less  confused  for  a  time,  or  more  frequently  he 
becomes  drow^sy  and  passes  into  a  deep  sleep  or 
stupor,  which  may  last  several  hours. 

Treatment. — During  the  convulsive  stage 
place  the  patient  in  a  safe  place  to  prevent  him 
from  hurting  himself  ;  put  a  piece  of  wood  or 
other  hard  substance  well  padded  between  his 
teeth  to  prevent  him  from  biting  his  tongue, 
loosen  all  tight  clothing  about  the  neck,  chest 
and  abdomen,  and  do  not  attem})t  to  restrain  the 
convulsive  movements  or  to  administer  anything 
by  the  mouth. 


nr 31  EDI  ATE   TREATMENT  OF  FITS  205 

After  the  convulsive  stage  has  passed  off  and 
the  patient  seems  drowsy,  encourage  natural 
sleep.  If  on  waking  he  seems  exhausted,  give 
him  a  little  soup  or  beef  tea,  but  do  not  give 
stimulants. 

2.  Hysterical  Fits.— These  occur  more  often 
in  females  than  males  and  are  ushered  in  with 
crying,  sobbing  or  laughing  without  any  cause  ; 
then  follow  jerky  movements  of  the  limbs  (not 
truly  convulsions),  at  the  same  time  the  breath- 
ing is  quickened,  the  eyelids  are  closed,  and  in 
severe  attacks  the  patient  falls  down  apparently 
but  not  actually  unconscious,  taking  care  never 
to  hurt  herself. 

Treatment.— The  best  treatment  for  hyster- 
ical patients  is  to  exclude  all  fussy  friends  and 
let  them  alone.  The  patient  will  come  to  her- 
self when  she  realizes  that  her  condition  is  excit- 
ing no  sympathy  or  alarm. 

3.  The  Convulsions  of  Infants. — These  are 
usually  caused  by  teething,  constipation,  indiges- 
tion, worms,  etc.,  but  they  may  be  due  to  fever 
or  brain  disease. 

Symptoms. — Just  before  the  occurrence  of  a 
fit  the  child  is  usually  peevish  and  fretful.  Dur 
ing  the  fit  the  body  first  becomes  stiff,  the  pulse 


206  FIRST  AID   TO   THE  INJURED 

is  rapid  and  weak,  the  breathing  is  hurried,  the 
skin  is  wet  with  a  cold,  clammy  perspiration,  and 
there  is  complete  loss  of  consciousness.  The 
rigidity  of  the  body  lasts  a  few  seconds,  and  is 
succeeded  by  a  stage  of  convulsive  movements  in 
which  the  muscles  of  the  face  twitch  and  the 
limbs  jerk  violently.  As  one  fit  passes  off  an- 
other may  supervene,  or  the  child  may  pass  into 
a  semi-comatose  condition  and  then  into  a  natu- 
ral sound  sleep. 

Treatment. — The  course  to  adopt  is  to  re- 
lieve as  quickly  as  possible  the  cerebral  circula- 
tion, therefore  place  the  child  at  once  in  a  bath 
as  warm  as  can  be  borne  comfortably  from  ten 
to  twenty  minutes,  or  put  the  feet  in  hot  water 
with  mustard  in  it ;  at  the  same  time  apply  cold 
sponges  to  the  head  and  quickly  change  them, 
and  send  for  medical  assfstance. 

4.  Uraemic  Convulsions. — In  the  course  of 
Bright's  disease  convulsions  and  unconsciousness 
may  occur. 

Treatment. — The  course  to  adopt  here  is  to 
encourage  the  action  of  the  skin,  therefore  place 
the  patient  in  bed  between  warm  blankets,  pack 
hot  water  bottles  round  him,  and  send  for  med- 
ical assistance. 


CHAPTER  IX 

burns  and  scalds  and  their  immediate 
treatment;  electric  shock  and  its  im- 
mediate treatment;  the  removal  of 
foreign  bodies  from  the  eye,  ear,  and 

NOSE 

Burns,  degrees  and  treatment  of  —Burns  from  Acids  and  Alka- 
lies, their  treatment — To  Extinguish  the  Flames  from 
Burning  Clothing — Shock  by  Electricity,  the  treatment  of 
— Removal  of  Foreign  Bodies  from  the  Eye,  Ear  and  Nose. 

BURNS  AND  SCALDS 

Burns  are  caused  by  the  application  of  a  fire  or 
dry  heat. 

Scalds  are  caused  by  the  application  of  hot 
liquids  or  moist  heat. 

Burns  are  divided  into  the  following  degrees, 
according  to  the  extent  of  injury  inflicted,  viz. : — 

1st  degree. — A  mere  reddening  of  the  skin. 

2d  degree. — The  formation  of  blisters. 

207 


20H  .    FIRST  AID    TO    TEE  INJURED 

3(1  degree. — Charring  and  the  destruction  of 
tissues. 

In  addition  to  the  actual  damage  caused  by 
burns  and  scalds  there  is  also  present : — 

(I)  Shock  to  the  System. — This  is  in  direct 
proportion  to  the  superficial  extent  of  the  burn. 
Burns  of  the  abdomen  and  chest  are  especially 
liable  to  produce  marked  shock,  and  in  children 
suffering  from  burns  and  scalds  the  shock  is 
usually  profound. 

(II)  Congestion  of  Internal  Organs. — This 
usually  comes  on  after  the  shock. 

Treatment.— In  the  management  of  burns 
and  scalds  the  following  points  have  to  be  borne 
in  mind  : — 

{a)     The  local  injury. 

(J)     The  shock  to  the  system. 

If  the  shock  is  severe  it  should  be  treated  first, 
and  the  local  injury  afterward,  when  reaction 
has  set  in. 

The  Local  Injury. — In  attending  to  a  burn 
care  should  be  taken  that  the  clothing  is  removed 
with  the  utmost  care  from  the  burnt  part,  and 
that  no  blisters  are  broken  in  removing  it.  The 
clothing  should  therefore  be  cut  off,  and  if  parts 
adhere  to  the  body  they  should    be   gently  re- 


nUENS  AND  SCALDS  209 

moved  after  first  soaking  them  in  oil ;  if  this  is 
not  sufficient,  the  part  should  first  be  immersed 
in  a  bath  of  warm  water.  If  the  burns  are  ex- 
tensive only  one  portion  of  the  body  should  be 
dressed  at  a  time,  the  rest  being  kept  covered  up. 

To  dress  the  Bicrns  proceed  as  follows :  Either 
apply  over  the  burnt  parts  pieces  of  lint  which 
have  been  soaked  in  carron  oil  (a  mixture  con- 
sisting of  equal  parts  of  linseed  oil  and  lime- 
water),  or  in  -carbolic  oil,  1  in  40,  or  in  a  saturated 
solution  of  common  washing  soda,  or  spread 
boracic  acid  ointment  (which  has  been  diluted 
with  an  equal  part  of  vaseline)  upon  pieces  of 
lint  and  apply  it  to  the  burnt  parts. 

J^ote. — Strong  antiseptics  for  dressing  burns 
should  be  avoided,  and  the  dressings  should  not 
be  changed  too  often. 

Burns  from  Acids. — First  drench  the  parts  with 
water,  wash  them  with  a  solution  made  by  dis- 
solving washing  soda  in  water,  and  then  treat  as 
for  an  ordinary  burn. 

Burns  from  Alkalies. — Drench  the  parts  first 
with  water,  then  \vash  with  a  solution  of  dilute 
vinegar  and  water,  and  finally  treat  as  for  an 
ordinary  burn. 

To  Extinguish  the  Flames  from  Burning  Cloth- 


210  FIRST  AID   TO   THE  INJURED 

ing. — Throw  the  person  clown  whose  clothes  are 
on  lire,  and  cover  him  up  as  quickly  as  possible 
with  a  rug,  coat,  shawl,  blanket  or  other  article 
of  covering. 

SHOCK  BY  ELECTRICITY 

This  may  be  produced  by  : — 

(I)  Natural  Electricity. — As  lightning. 

(II)  Artificial  Electricity. — As  currents  from 
telegraph,  telephone,  electric  lighting  and  motor 
wires. 

Natural  Electricity. — The  effects  of  lightning 
vary  according  to  circumstances ;  there  may  be 
only  slight  shock  with  dizziness,  or  there  may  be 
violent  convulsions,  insensibility  or  immediate 
death. 

Artificial  Electricity. — The  danger  of  a  current 
of  electricity  is  in  proportion  to  its  intensity — 
thus,  the  low  tension  currents  of  the  telephone 
and  telegraph  wires  would  probably  only  produce 
slight  shock,  while  the  high  tension  currents  (and 
especially  the  alternating  ones),  for  lighting  and 
motor  purposes  are  extremely  dangerous. 

The  current  from  a  dynamo  may  be  10,000 
volts,  for  arc  lamps  the  current  is  usually  2,400 
volts,  and  for  lighting  (in  houses)  100  volts. 


SHOCK  BY  ELECTRICITY  211 

A  current  of  100  volts  would  be  very  danger- 
ous, a  current  of  from  20  to  30  volts  is  as  much 
as  can  be  comfortably  borne  by  a  strong  man. 

When  electric  wires  have  a  current  passing 
through  them,  they  are  termed  live  wires,  and  it 
is  from  these  that  there  is  danger,  as  they  may 
be  exposed  either  by  accident  or  for  repairs. 

Symptoms. — A  person  taking  hold  of  naked 
live  wires  {i.  e.,  those  that  are  not  covered  with 
an  insulating  material),  wnth  a  current  of  high 
tension  passing  through  them,  would  most  likely 
be  violently  convulsed  and  be  unable  to  let  go, 
or  there  might  be  insensibility  with  suspended 
animation  or  even  death.  Parts  of  the  body  or 
clothes  in  contact  with  the  wires  may  be 
scorched  or  burnt. 

Treatment. — Here  proceed  as  follows : — 

(I)  Kemove  the  sufferer  from  the  source  of 
danger;  this  must  be  done  with  the  greatest 
care,  or  the  person  giving  assistance  may  himself 
receive  the  shock  and  be  rendered  incapable. 

"  When  the  injured  person  retains  his  hold  of 
the  wire,  it  is  dangerous  to  touch  any  part  of 
him,  even  the  parts  of  the  body  covered  by 
clothes."  A  case  of  this  kind  is  recorded  in  the 
Electrical  Review — "  While  a  man  was  cleaning 


2i2  FIRST  AID    TO    THE  INJURED 

an  electric  street  lamp  in  Boston,  he  received  a 
shock  and  was  killed,  his  body  being  suspended 
from  the  wires ;  a  man  who  endeavored  to  re- 
move the  body  came  in  contact  with  the  current 
and  was  dashed  to  the  ground  with  such  violence 
that  he  died  shortly  afterward." 

Therefore  before  removing  the  sufferer,  first 
protect  the  hands  whenever  possible  with  india- 
rubber  gloves  (these  are  used  in  electrical  works 
and  ma}^  be  at  hand),  if  these  cannot  be  procured, 
first  wrap  a  mackintosh  coat  or  a  thick  dry 
woolen  cloth  coat,  or  other  dry  article  of  cloth- 
ing round  the  patient  (damp  articles  of  clothing 
are  good  conductors  of  electricity,  and  the  suffer- 
er's own  clothes  may  be  damp  from  perspiration), 
and  then  pull  the  sufferer  away  from  the  source 
of  danger. 

(II)  Send  at  once  for  medical  assistance,  but 
in  the  meanwhile  place  the  patient  in  a  comfort- 
able position,  loosen  all  tight  clothing  round  the 
body,  and  if  there  is  any  difficulty  with  the 
breathing  begin  at  once  to  perform  artificial 
respiration. 

Two  live  naked  wires  of  which  the  sufferer 
may  have  hold,  may  be  short  circuited  by  drop- 
ping (not  placing,  as  then  the  assistant  might  get 


REMOVAL   OF  FOREIGN  BODIES  213 

the  shock),  an  iron  bar  or  other  metallic  tool 
across  them,  in  this  way  carrying  the  current 
from  one  wire  to  the  other  instead  of  through 
the  body  of  the  sufferer. 


REMOVAL  OF  FOREIGN  BODIES 

1.  From  the  Eye — Foreign  bodies  may  be 
removed  from  the  surface  of  the  eye  as  follows. 
If  under  the  upper  lid,  first  evert  the  lid  by 
placing  a  bodkin  or  match  over  it,  and  then 
gently  pull  the  lid  over ;  in  this  way  the  whole 
of  the  upper  surface  of  the  conjunctiva  is  exposed 
and  may  be  very  gently  swept  over  with  a 
camel's  hair  brush,  or  with  a  piece  of  soft  linen 
dipped  in  warm  water. 

If  under  lower  lid,  the  whole  of  the  conjunctiva 
under  the  lower  lid  may  be  exposed  by  gently 
pulling  the  eyelid  down  with  a  finger,  and  the 
foreign  body  removed  as  described  above. 

2.  From  the  Ear.— Great  care  should  be  taken 
in  these  cases  not  to  poke  any  sharp  instruments 
into  the  ear,  as  the  drum  might  easily  be  in- 
jured ;  warm  glycerine  or  oil  may  be  poured  into 
the  ear  and  the  organ  gently  syringed  out  with 
warm  soapy  water. 


214  FTBST  aid    to   the  INJURED 

3.  From  the  Nose — The  nose  should  eithei 
be  blown  forcibly,  or  gently  syringed  out  with 
warm  water,  or  the  patient  may  be  made  to  snitl 
pepper  and  sneeze. 


CHAPTER  X 

PREPARATION    FOR   THE  RECEPTION  OF  A  CASE 
OF    ACCIDENT   OR   SUDDEN   ILLNESS 

Selection  and  Preparation  of  the  Room— The  Bedstead  and 
Bed — How  to  put  on  a  Draw-sheet — Fracture  Bed— Carry- 
ing the  Patient  up-stairs  to  his  Room— Removing  the 
Clothes — Lifting  the  patient  into  bed — Preparation  for  the 
Surgeon's  visit. 

While  engaged  in  attending  to  a  case  of  acci- 
dent or  sudden  illness,  if  possible,  send  a  mes- 
senger to  the  patient's  house,  in  order  that 
arrangements  may  be  made  for  his  reception. 

I.     Selection  and  Preparation  of  the  Room. 

(I)  Selection  of  the  Room. — The  points  to 
attend  to — as  far  as  possible — are  :  that  the  room 
should  be  easily  accessible,  it  should  be  large  and 
lofty  with  a  south  or  southwest  aspect,  the  win- 
dows should  admit  sufficient  light,  and  should  be 
made  to  open  top  and  bottom,  and  there  should  be 
a  fire-place  with  a  chimney  that  does  not  smoke. 

(II)  Preparation   of  the   Roo7n. — The   room 

215 


216  FIRST  AID    TO    THE  INJURED 

should  be  thoroughly  cleansed  (if  time  will  per- 
mit of  it),  well  ventilated  by  drawing  down  the 
top  windows,  a  tire  should  be  lighted  in  it,  it 
should  be  warmed  to  a  temperature  of  60°  Fahr. 
and  maintained  at  this,  a  thermometer  being 
hung  in  the  room  for  the  purpose  of  regulating 
the  temperature  ;  the  carpet  and  all  superfluous 
furniture  should  be  removed  from  the  room. 
2.    The  Bedstead  and  Bed. 

(I)  The  Bedstead. — Wide  bedsteads  are  to  be 
avoided,  as  the  patient  cannot  be  easily  got  at; 
the  best  kind  of  bedstead  to  use  is  an  iron  one, 
3  to  3^  feet  wide  b}^  6^  feet  long,  it  should  be 
placed  away  from  the  wall  (so  that  it  can  be 
approached  from  either  side),  and  if  possible 
across  the  room  between  the  door  and  fireplace 
with  the  head  facing  the  window. 

(II)  The  Bed. — Feather  beds  and  flock  mat- 
tresses are  to  be  avoided  ;  hair  mattresses  are  the 
best;  the  bed  clothes  should  be  light  and  warm, 
no  vallances  or  curtains  should  be  used,  and  care 
should  be  taken  that  the  space  under  the  bed- 
stead is  vacant. 

The  bed  should  be  made  and  the  bed  clothes 
well  turned  down,  two  stout  chairs  should  be 
placed    next  to  the   bed,  on  which   to  rest  the 


PREPARATION  217 

stretcher  while  the  patient  is  being  undressed. 
It  may  (in  cases  where  the  injuries  are  severe,  or 
mud-stained  clothes  have  to  be  removed  or  ex- 
tensive dressings  applied),  be  necessary  to  have  a 
second  bed  or  couch  in  the  room  on  which  to 
first  lay  the  patient.  Extra  blankets  and  hot 
w^ater  bottles  should  be  kept  in  readiness. 

In  cases  of  collapse  the  blankets  should  be 
made  hot  and  flannel  should  be  wrapped  round 
the  hot  water  bottles. 

If  there  is  any  likelihood  of  the  bed  clothes 
being  soiled,  i.  e.,  in  cases  of  extensive  injury,  or 
w^here  dressings  have  to  be  applied,  or  where  the 
patient  is  unconscious  or  extremely  weak  and 
passes  his  evacuations  under  him,  a  draw-sheet 
should  be  placed  on  the  bed. 

To  put  on  a  Draw-Sheet — proceed  as  follows  : — 

Procure  a  large  cotton  sheet,  fold  it  length- 
ways into  four  and  place  it  across  the  bed  so 
that  it  will  reach  from  just  below  the  patient's 
shoulders  to  his  knees,  now  place  a  piece  of  oil- 
cloth or  other  waterproof  cloth  between  the 
draw-sheet  and  the  under  sheet,  the  draw-sheet 
being  about  four  inches  wider  than  the  oilcloth; 
one  end  of  the  draw-sheet  is  tucked  in  under  the 
mattress,  the  other  end  is  rolled  up  on  the  oppo- 


218  FIRST  AID    TO    THE  INJURED 

site  side  of  tlie  bed  ;  when  the  part  of  the  draw- 
sheet  under  the  patient  becomes  soiled  it  is 
withdrawn  a  little  to  one  side  by  being  rolled  up 
a  little  more. 

In  cases  of  fracture  where  the  patient  will 
have  to  lie  in  bed  for  several  weeks,  it  is  im- 
portant to  have  a  properly  arranged  bed — termed 
a  " fracture  bed." 

The  Essentials  of  a  "  Fracture  Bed  "  are  : 

(I)  That  there  should  be  no  sagging  or  giving 
way ; 

(II)  That  the  surface  should  be  evenly  smooth 
and  comfortably  elastic ; 

(III)  That  the  foot  of  the  mattress  should  be 
a  little  higher  than  the  head. 

The  best  way  to  arrange  a  fracture  bed  is  as 
follows  :  first  place  a  straw  mattress  on  the  bed- 
stead, then  on  the  mattress  place  two  horsehair 
mattresses  3^  to  4  inches  thick,  and  on  the  top 
mattress  one  blanket ;  to  raise  the  bedstead  place 
a  thin  board  under  the  legs  at  the  foot. 

In  fracture  of  the  lower  extremity  or  of  the 
spine,  there  should  be  no  bolsters  or  pillows  for 
the  head,  but  only  a  thin  cushion,  and  boards 
should  be  placed  across  the  bed  under  the  mat- 
tress. 


PREPARATION  219 

A  cradle  to  take  off  the  weight  of  the  bed 
clothes  may  be  necessary  in  fracture  of  the  lower 
extremity,  or  sprain  of  the  ankle  joint ;  for  a 
cradle,  a  cardboard  box  with  the  ends  cut  out,  or 
a  three-legged  stool,  may  be  used. 

3.  Carrying  the  Patient  Upstairs  to  His 
Room. — Before  removing  the  patient  to  his 
room,  the  hall  and  staircase  should  be  so  far 
cleared  as  to  allow  sufficient  room  for  those 
carrying  him  to  pass. 

The  particular  method  to  be  adopted  for  carry- 
ing will  depend  in  each  case  upon  the  nature  and 
extent  of  the  injury,  and  the  condition  of  the 
patient. 

A  patient  may  be  carried  up-stairs  — 

(I)  On  a  stretcher.  Here  the  head  should 
go  first,  and  the  two  bearers  at  the  foot  should 
take  care  to  keep  the  stretcher  as  nearly  hori- 
zontal as  possible  by  raising  it,  or 

(II)  By  placing  the  patient  in  a  strong  chair 
and  carrying  him  up  backwards,  while  a  third 
person  walks  after  the  chair,  helps  to  support  it, 
and  prevents  the  patient  from  falling  out. 

4.  Removing  the  Clothes.— Before  putting  the 
patient  to  bed  the  clothes  should  be  first  removed, 
and  great  care  should  be  taken  in  doing  this  ;  in 


220  FIEIST  AID    TO    THE  INJURED 

serious  cases  it  is  better  to  remove  the  clothes  by 
cutting  thein  away. 

In  removing  a  coat  irom  an  injured  arm, 
draw  out  the  uninjured  arm  first,  and  in  putting 
on  anything  put  the  injured  arm  in  first. 

In  removing  trousers  from  an  injured  limb  rip 
up  the  outside  seam. 

In  removing  clothing  in  cases  of  burns  and 
scalds,  cut  away  the  parts  which  are  not  adher- 
ing, and  soak  the  adhering  parts  well  with  oil 
before  removing  them. 

5.  Lifting  the  Patient  into  Bed.— This  may  be 
done  as  follows  : — 

(I)  If  the  bed  is  narrow  and  there  is  room  for 
the  stretcher,  place  it  on  the  floor  with  the  head 
close  to  the  foot  of  the  bed,  three  bearers  can 
then  .lift  the  patient,  head  foremost,  over  the 
foot  of  the  bed. 

(II)  If  the  bed  is  wide,  place  the  stretcher 
close  alongside  the  bed,  the  patient's  head  cor- 
responding to  that  of  the  bed,  Nos.  1,  2  and  3 
bearers  place  themselves  on  the  far  side  of  the 
stretcher,  and  No.  4  bearer  on  the  near  side  ;  the 
patient  is  then  lifted,  and  supported  on  the  knees 
of  Nos.  1,  2  and  3  bearers.  No.  4  bearer  pulls 
awav  the  stretcher  and  stands  aside,  while  the 


PREPARATION  221 

Other  bearers  lift  the  patient,  stand  up,  and  place 
him  in  position  on  the  bed. 

6.  Preparation  for  the  Surgeon's  Visit. — When 
summoning  a  doctor,  inform  him  as  far  as  possi- 
ble of  the  nature  of  the  case  so  that  he  may 
come  prepared. 

The  following  should  be  in  readiness : — 

Plenty  of  hot  and  cold  water,  clean  towels  and 
soap,  and  a  receptacle  for  dirty  water. 

Fo7'  Burns  and  Scalds. — A  good  supply  of 
clean  old  linen,  cotton  wool,  olive  oil,  "carron  " 
Dil  and  bandages. 

i^6>/'  Ilcemorrhage. — Ice,  sponges  and  plenty  of 
water. 

J^or  Drowning. — Plenty  of  blankets  heated 
before  the  fire  and  several  hot  water  bottles,  the 
sheets  from  the  bed  should  also  be  removed. 

If  poultices  and  fomentations  are  required, 
plenty  of  boiling  water;  linseed  meal,  mustard,  a 
small  basin,  a  large  spoon,  olive  oil,  tow,  flannel, 
a  kitchen  roller  and  two  sticks  or  a  large  towel. 


Ind 


ex 


A  BDOMKN,  bandage  for  26,  66 

Acetylene  poisoning    .    .    185 

Acids  acetic  poisoning,  etc.  177 

arsenious  poisoning  .    .    181 

carbolic  poisoning    .        178 

carl)onic  poisoning  .    .    185 

glacial  acetic  poisoning  177 

hydrochloric  poisoning  177 

hydrocyanic    poisoning  178 

muriatic  poisoning  .    .    177 

nitric  poisoning    .    .    .    177 

oxalic  poisoning        .    .    178 

poisoning  from      .    .    .    177 

prussic  poisoning  .    .    ,    178 

sulphuric  poisoning  .    .    177 

Aconite  poisoning     ...    179 

Alcohol  poisoning     .    .    .    180 

for  wounds Ill 

199 

180 
180 
180 
180 

180 
178 
188 

181 
181 


Alcoholic  intoxication     . 
Alkalies,  ammonia  caustic 
poisoning 

liniment  poisoning 

lime  poisoning  .    . 

potash  poisoning  . 

soda  poisoning  .    . 
Almond  Flavor  poisoning 
Aniline  dyes  poisoning   . 
Antimonial  wine  poison- 
ing      .... 
Antimony  poisoning    .    . 


chloride    of,    poisoning  181 

tartarated   poisoning  .  181 

Aperients  in  poisoning   .  176 

castor  oil  as 176 

sulphate  of  magnesia  as  176 

Apoplexy 198 

Aqua  fortis  poisoning  .  .  177 
Arnica  poisoning  ...  186 
Aromatic  vinegar  poison- 
ing ....  177 
Arsenic,  white  poisoning  181 
Artery,  axillary    ....  84 

brachial      85 

common  carotid    ...  83 

facial 83 

femoral 86 

occipital 83 

popliteal 87 

posterior  tibial  ....  88 

anterior  tibial    .        .    .  88 

radial      85 

subclavian     ....  84 

temporal 82 

ulnar       85 

Artificial  respiration     98,  157 

Hall's  method         .  157,  161 

Howard's  method  .  157,  160 

Sylvester's  method      .  157 

Asphyxia  from    blocking 

larynx     ...  169 


223 


224 


INDEX 


choking 169 

drowning 165 

hanging 17u 

poisonous  gases    .    .    .  170 

strangulation     ....  170 

Atropine  poisoning      .  182 

Axillary  artery     ....  84 

Back,  bandage  for  wound  25 

Back  of  head,  bandage  for  22 

Bandages 11 

capeline 60 

elastic 41 

for  fixing  splints  .    .  38 

kinds  of 11 

knotted 63 

looped  triangular      .    .  39 

names  of  part  of   .    .    .  42 

non-elastic 41 

roller  .    .                    .    .  40 

application  of    .    ,    .  42 

circular       44 

figure  of  8 46 

for  abdomen  ....  66 

arm 56 

breast 52 

chest 65 

elbow 55 

finger 58 

foot 59 

groin 48 

hand 56 

head    .....  60 

heel         53 

hip 48 

knee 55 

leg 59 

shoulder     ....  50 

many-tailed  ....  72 

oblique 46 

reverse  spiral     ...  45 


Bandages  (con ti nued ) 
simple  spiral 
.sizes  of    .    .    . 
spica  for  breast 
elbow  .    .    . 
groin  and  hip 
heel     .    . 
knee    .    . 
shoulder 
thumb    . 
table  of  .    . 
twisted    .    . 
semi-elastic    . 
special     .    .    . 
four-tailed 
many-tailed 
square     .    . 
T      .... 
Squire's     method 

hand 

to  fasten     .    . 

fold     .    .    . 

roll      .    .    . 

triangular    .    . 

for  abdomen 


for 


45 
41 
52 
55 
48 
53 
55 
50 
53 
66 
63 
41 
69 
69 
72 
69 
73 


arm 

back 

back  of  head  .... 

chest 

elbow . 

for  elbow,  fracture  of 

eye 

for  femur 
fist   .    . 


32 

16 

15 

42 

12,  15 

26,  35 

.   26 


25 
22 
25 

27 

143 

.  .  .  .    22 

fracture  of  148 

31 


for  folding,  for  storage  13 

broad   and  narrow  15 

foot 33 

fracture     of     hand  146 

forehead      ....  22 

fractures     ....  37 

groin 37 


INDEX 


225 


Bandages  (continued) 

haemorrhage  ...      40 

hand 28,  31 

head 22 

hip      ......      33 

humerus,     fracture 

of 141 

jaw,  fracture  of  .  129 
leg,  fracture  of  .  .  155 
lower  jaw  ....    129 

palm 30 

patella,  fracture  of  153 
pelvis,    fracture  of  134 

"reef" 16 

ribs,  fracture  of    .    132 
shoulder     ....      24 
sling,  large  for  fore- 
arm     ....      17 

elbow 17 

small 25 

stump 37 

temple 22 

tourniquet     ...      94 

wounds 20 

narrow  fold   ....      92 

uses  of 11 

Base  of  skull,  fracture  of  328 
Battley's  solution  poison- 
ing   188 

Bed,  for  accidents  .  .  .  216 
Bed-fracture,  essentials  of  218 
Bedstead  for  accidents  .  216 
Belladonna  poisoning  .  .  182 
Bites  by  mad  dogs   .    .    .    116 

snakes        115 

Bitter  almonds  poisoning  178 
Black  drops  poisoning  .  188 
Bleeding   from    the    nose 

103,  106 

Blister    Beetle    poisoning  182 

fluid  poisoning      ...    182 


Blood  spitting 103 

Blue  rocket  poisoning  .  179 
stone  poisoning  ...  184 
vitriol  poisoning  .  .  .  184 
Brachial  artery  ....  85 
Breast,  bandage  for  female  52 
Breathing,  to  restore  from 

drowning   .    .    165 
Burnett's  fluid  poisoning  190 
Burning  clothing,   to  ex- 
tinguish flames 

of 209 

Burns  and  scalds  .    .  20"^  221 

from  acids 209 

alkalies 209 

Camphene  poisoning     .    190 
Camphor  essence  poison- 
ing   183 

Liniment  poisoning     .    180 
spirit  poisoning    ...    183 
Cantharides  poisoning     .    182 
carotid  artery    ....      83 
Capeline  bandage     ...      60 
Carbolic  acid  poisoning  .    178 
Carbonic  poisoning  ...    185 
oxide  gas  poisoning      .    185 
Carrying  and  lifting  pa- 
tients ....    220 

patients 219 

Caustic,  lunar,  poisoning  183 
Cleansing  wounds  .  .  .  Ill 
Collar  bone,  fracture  of  .    135 

Colles  fracture 146 

Compound  fracture,  im- 
mediate treat- 
ment of  .    .    .    127 

of  tibia 120 

Compression    of    axillary 

artery      ...      85 
by  forced  flexion  .      89 


226 


INDEX 


brachial  artery  .    .    . 

85 

Demulcents  in   poisoning 

177 

by  forced  flexion 

89 

Digital      compression     of 

brain    

197 

haemorrhage  . 

81 

carotid  artery    .    .    . 

83 

Dislocations 

118 

common   femoral  ar- 

Dover's powder  poisoning 

188 

tery     .... 

86 

Draw  sheet,  to  put  on 

217 

facial  artery       .    . 

83 

Drowning,    treatment    of 

occipital  artery  .    .    . 

83 

apparent  death 

popliteal     artery    by 

from    ,    . 

104 

forced    flexion 

93 

what  things  to  prepare 

radial  and  ulnar  ar- 

in case  of    .    . 

221 

teries  .    . 

85 

subclavian  artery      . 

84 

Ears,  removal  of  foreign 

superficial       femoral 

bodies  from    . 

213 

artery      .    .    . 

89 

bandage  for 

22 

temporal  artery 

82 

Elbow,  iDandage  for  .    .  '^^ 

^  '5 

Concussion  of  the  brain  . 

197 

joint,  fracture  of  .    .    . 

143 

Condy's  fluid  for  wounds 

111 

Electricity 

210 

Constitutional  symptoms, 

Emetics,  caution  as  to     . 

175 

treatment  of  . 

97 

for  use  in  case  of  poi- 

Constriction of  whole  limb 

92 

soning     . 

175 

Convulsions 

205 

Epileptic  fits 

204 

of  infants           .... 

205 

Epistaxis    .    .            ... 

1(6 

urfemic 

206 

Ergot  of  rye  poisoning     . 

185 

Co])[)er  acetate  poisoning 

184 

Ergotine  poisoning  .    .    . 

185 

sulphate  poisoning    .    . 

184 

Esmarch's  elastic  tube    . 

92 

Corrosive  poisons  .        .    . 

172 

tourniquet 

\-Q 

sublimate  poisoning 

187 

Ether  poisoning    .... 

185 

Cranium,  fracture  of    .    . 

27 

Expiration,   how    to   i)ro- 

Crayons,  poisonous    .  181. 

186 

duce    .... 

159 

Cyanide  of  potassium  poi- 

Eyes. l)andage  for  wounds 

soning     .    .    . 

178 

of 

22 

Cytisine  poisoning        .    . 

186 

removal    of    foreign 

bodies  from    . 

213 

Daley's  c  a  1  m  i  n  a  t  i  v  e 

poisoning   .    . 

188 

Face,  bandage  for  side  of 

22 

Deadly  nightshade  poison- 

Facial artery 

83 

ing  .        ... 

182 

Fainting 

193 

Death,  appearances  accom- 

Female   breast,     bandage 

panying  in  as- 

for  

52 

phyxia    .    .    . 

170 

Femoral  artery      .... 

86 

INDEX 


007 


iVinur,  fracture  of   .    . 

147 

subclavian  artery 

84 

Field   and   screw   tourni- 

temporal artery     .    . 

82 

quets  .... 

97 

tibial  artery  .... 

88 

Finder  l)andage     .... 

58 

ulnar  arteiy   .... 

85 

fracture  of 

146 

immediate  treatment  . 

75 

Fire,    to     extinguish     in 

external      .    .       99- 

-102 

clothes    .    .    . 

209 

internal 

103 

Fits 

204 

situation  of    .        ... 

75 

Flexion,  forced      .    . 

89 

to  arrest  .... 

40 

Fly  papers,  poisonous 

181 

treatment  of  external  . 

99 

Foot,  bandage  for     .    .    . 

3:i 

triangular    bandage    to 

Forearm,  bandage  for 

28 

arrest  .... 

40 

Forehead,  bandage  for 

22 

varieties  of     .    . 

76 

Foreign  bodies,  removal  of 

213 

venous  ...          40,  77 

',  78 

Hair,  dyes  poisoning 

186 

Godfrey's    cordial    poi- 

Hall's method  of  artificial 

soning     .    .    . 

188 

respiration  157, 

161 

Great  toe,  bandage  for    . 

53 

specific  poisoning      ... 

181 

Greenstick      fracture     of 

Hand,  bandage  for  .    .    . 

28 

radius      .    .    . 

121 

fracture  of 

146 

Groin,  bandage  for  .    .    . 

37 

Squire's      method     for 

bandaging  .    . 

32 

H^IMATEMKSIS       .... 

105 

Hanging,    asphyxia  from 

170 

Haemoptysis       .... 

104 

Head,  bandage  for         .    . 

60 

Haemorrhage 

75 

four-tailed  bandage  for 

70 

arterial  

77 

Heel,   l)andage   for  .    .    . 

53 

articles     required    for 

Henbane  poisoning  .    .    . 

186 

controlling 

221 

Hip,  bandage  for          ,    . 

33 

causes  of 

75 

Holly  berries  poisoning  . 

186 

caution  respecting    .    . 

40 

Hooper's  Specific  poison- 

definition of 

75 

ing 

181 

"first  aid  "for     .    .    . 

80 

Howard's  method  of  arti- 

from axillary  artery     . 

84 

ficial     respira- 

brachial artery  .    .    . 

85 

tion          .  157, 

160 

common    carotid    ar- 

Humerus, fracture  of  .    . 

141 

tery          ... 

83 

Hydrocyanic  acid  poison- 

facial artery          .    . 

83 

ing  . 

178 

femoral  artery  .    .    . 

86 

Hyoscyamine  poisoning  . 

186 

occipital  artery      .    . 

83 

Hysterical  fits    .    . 

205 

popliteal  artery     .    .      87 
radial  artery  ....       85 


IcE-CKEAM,  poisonous         181 


228 


INDEX 


Infants,  convulsions  of    .  205 

Insects,  stings  of  .    .    .    .  115 

Insensibility      192 

test  for 201 

Intoxication,  alcoholic    .  199 

Iodine  poisoning  ....  186 

Iodoform  poisoning  .    .    .  186 

Irritant  poisons    ....  173 

Jaw,  four-tailed  bandage 

for 69 

fracture  of 129 

Knee,  bandage  for   .    .  33,  55 

four-tailed  bandage  for  71 

Knot,  reef 16 

sailor's 16 

Knotted  bandage     ...  63 

Labuknum  poisoning     .  186 

Laudanum  poisoning  .    .  188 

Laurel  water  poisoning  .  178 

Lead  poisoning     ....  186 

acetate  poisoning  ...  186 

paint  poisoning     .    .    .  186 

sugar  of,  poisoning  .    .  186 

•white  poisoning    ...  186 

Leg,  bandage  for  ...    .  33 
Limbs,  extremities  of,  fix- 
ing splints  to     38 

Lime,  caustic  poisoning  .  180 

quick  poisoning    ...  180 

Liqueurs  poisoning  .    .    .  188 
Lower     extremities,     t  o 

bandage  ...  59 

Lungs,  bleeding  from  .    .  104 

Many-tailed  bandage  .  72 
Matches,  poisoning  .    .    .  189 
Mercury,  acid  nitrate  poi- 
soning    .    .    .  187 


perchloride  poisoning  .  187 

red  oxide  of,  poisoning  187 

Metacarpus,  fracture  of  .  146 

Monkshood  poisoning  .    .  179 

Morphine  poisoning     .    .  188 

Mushrooms,  poisonous    .  185 

Mussels,  poisonous  ...  187 

Narcotic  poisons  .  .  .  199 
Neck,  bandage  for  wound 

of 24 

Nepenthe  poisoning  .  .  188 
Neuraline  poisoning  .  .  179 
Nicotine  poisoning  .  .  .  190 
Nitrate  of  silver  poisoning  183 
Nitric  acid  poisoning  .  .  177 
Nitro-benzol  poisoning  .  188 
Nitrous  acid  gas  poisoning  188 

Nose,  bleeding 106 

removal    of    foreign 

bodies  from    .    214 

Occipital  artery  ...  83 
Oil  of  almonds  poisoning  178 
vitriol  poisoning  .  .  177 
Opium  tincture  poisoning  188 
Wine,  of,  poisoning  .  188 
Oxalic  acid  poisoning  .    .    178 

Paraffin  oil  poisoning  189 
Paregoric  poisoning  .  .  188 
Patella,  fracture  of  .  .  .  153 
Peach  kernels  poisoning  178 
Pelvis,  fracture  of  ...  1 34 
Perineum,  bandage  for  .  35 
Phenol  poisoning  .  .  .  178 
Phosphorous  poisoning  .  189 
Poisoned  bites 115 

wounds 114 

Poisoning,  classification  of  172 

definition  of 172 


INDEX 


229 


depression  from    .    .    .  175 

evidence  of 173 

general  treatment  for  .  174 

history  of 174 

how  to  act  in     ....  174 

immediate  treatment  of  172 

pain,  relief  of,  in  .    .    .  175 

shock  from 175 

unknown,  general  treat- 
ment  ....  174 
Poisonous  fish  and  meat  187 
Poisons,  acetate  of  copper  184 

lead 186 

acids 177 

acetic 177 

arsenious 181 

carbolic 178 

carbonic 185 

hydrochloric  ....  177 

hydrocyanic  ....  178 

nitric 177 

oxalic 178 

prussic 178 

sulphuric 177 

aconite 179 

liniment  of    ....  179 

aether 185 

after  damp 185 

alcohol 180 

alkalies 180 

ammonia 180 

caustic 180 

liquid 180 

liniment     ....  180 

lime 180 

caustic 180 

quick 180 

potash 180 

caustic 180 

soda 180 

caustic 180 


178 

178 
180 
188 
187 
181 
181 
181 
176 


176 


almond  flavor   . 

oil 

ammonia    .    .    . 
aniline  dyes  .    . 
animal  alkaloids 
antimony   -    .    . 

tartarated  .  . 
antimonial  wine 
aperients  for  .    . 

castor  oil,  sulphate  of 
magnesia  (Ep- 
som salts)  .    . 
aqua  fortis 177 

Tofania 181 

arnica 186 

aromatic  vinegar  .    .    .    177 
arsenic 181 

white 181 

arsenious  acid    ....    181 

atropine 182 

Battley's  vermin  killer  188 

sedative  solution  .    .    188 
bean,  St.  Ignatius    .    .    188 

belladonna 182 

benzol 188 

berries,  holly     ....    186 
bites,  mad  dog  and 

snake  ...  116 
bitter  almonds  ....    178 

black  drops 188 

blister  beetle     ....    182 

fluid 182 

blue  rocket    .    .    •  .    .    179 

stone 179 

vitriol 184 

brandy 180 

Burnett's     disinfecting 

fluid  ....  190 
Butler's  vermin  killer,  188 
calminative,  Dalby's  .  189 
camphene 190 


230 


INDEX 


Poisons  (con tinned) 

camphor  .183 

essence  of 1 83 

liniment 183 

spirits      183 

cantliarides    .....  182 

carbolic  acid 178 

carbonic  acid     ...  185 

gas 185 

oxide  gas 185 

caustic  ammonia  .    .    .  180 

lime 180 

lunar 183 

potash 180 

soda 180 

chalks,  P>ench    .    .  181,  186 

charcoal  fumes  ....  185 
chloral    .....        .183 

hydrate 183 

syrup      183 

chloride  of  antimony  .  181 

lime         183 

chlorine  gas 183 

chlorodyne 188 

chloroform,  inhaled  183 

swallowed 184 

choke  damp 185 

coal  gas 185 

codeine 188 

compound  camphor  lini- 
ment ....  183 

copper 184 

acetate 184 

sulphate 184 

cordial,  Godfrey's     .    .  188 

corrosive  acids  ....  178 

sublimate 187 

corrosives 177 

crayons 181,  186 

croton  oil 185 

cyanide    of     potassium  178 


Poisons  (continued) 

Dal1)y's  calniinative  188 

deadly  nightshade  .  .  182 
demulcents  for 

arrowroot,  barley 
w  a  t  e  r,  eggs 
(raw),  flour  and 
water,  gruel, 
linseed  tea, 
milk,  olive  oil  177 

dog  bites J 16 

Dover  powder  .    .        .188 

drops,  black 188 

elixir,  Godfrey's  .  .  .  188 
enierald  green  ....  181 
emetics  for 

ipecacuanha  powder, 
ipecac  uanha 
wine,  mustard, 
salt,  sulphate 
of  zinc,  tepid 
water  .  .  .  175 
enema  for 

beef   tea,   spirits,  tea 

or  coffee  .    .        177 

ergot  of  r^'e 185 

ergotine 185 

essence  of  camphor  .    .    183 

henbane      ...    188 

ether,  inhaled    ...        185 

fish,  poisonous  ....    187 

fly  fungi 185 

papers 181 

French  chalks  .  .  181,  186 
friend   and  soothing 

syrup,  mother's  188 
fruits,  tinned     ....    181 

fungi 185 

gases 185 

acetylene 185 

after  damp     ....    185 


INDEX 


231 


Poisons  (continued) 
carl)onic  acid 
oxide  .    .    . 
charcoal  fumes 
chlorine      .    . 
choke  damp  . 
coal  gas 
marsh  gas 
nitrous  oxide 
sewer  gas   .    . 

gill 

glacial  acetic  acid 

Godfrey's    cordial 
elixir 

hair  dyes    .    .    . 

hartshorn   .    .    . 

henliane  .... 

holly  berries 

Hall's  specific 

Hooper's  specific 

Hunter's  chloral 

hydrate  of  chloral 

hydrochloric  acid 

hydrocyanic  acid 

hyoscyamine 

hyoscyamus  .    . 

ices,  cheap 

Ignatius,  St. 

insect  stings 

iodine      .    . 

iodoform 

irritants 

laburnum 

laudanum 

laughing  gas 

laurel  water 

lead  .  , 
acetate  . 
hair  dyes 
paint  .  . 
sugar  of  . 


bean 


and 


185 
185 
185 
183 
185 
185 
185 
188 
185 
180 
177 


188 
186 
180 
186,  188 
186 
181 
181 
183 
183 
177 
178 
186 
186 
181 
188 
116 
186 
186 
173 
186 
188 
188 
178 
186 
186 
186 
186 
186 


Poisons  (continued) 

white 186 

lime,  caustic 180 

quick       180 

liniment,  aconite  .  .  179 
ammonia  ....  18U 
belladonna  ....  182 
camphor         ....    183 

liqueurs  188 

lunar,  caustic    ....    183 
mad  dog  Ijites   ....    116 

matches 189 

mercury 187 

acid  nitrate    ....    187 
perchloride     ....    187 
red  oxide    .....    187 
red  and  white  precip- 
itate   ....    187 
methylated  spirit         .    180 
mineral  green    ....    181 
monkshood        ....    179 

morphine 188 

mother's     friend     and 

soothing  syrup  188 
177 
185 
187 
I'/S 
173 
179 
190 
182 
183 
177 
188 
188 
188 
188 
178 
178 
190 


muriatic  acid 
mushrooms    .    .    . 

mussels 

narcotic 

narcotic-irritants 
neuraline 
nicotine  .    . 

nightshade,  deadly 
nitrate  of  silver  . 
nitric  acid  .  .  . 
nitro-benzine  .  . 
nitro-benzol  .  .  . 
nitrous  oxide  gas 
uux  vomica  .  .  . 
oil  of  almonds  .  . 
bitter .... 
turpentine     .    . 


232 


INDEX 


Poisons  (continued) 

oil  of  vitriol 177 

opium     .......    188 

oxalic  acid 178 

oxide  of  mercury  .    .    .    187 

paint,  lead 186 

paraffin  oil 189 

paregoric    ......    188 

paste  for  rats  .    .    .  181,  189 
peach  kernels    ....    178 

perchloride  of  mercury  187 

phenol 178 

phosphorus    ....    189 

paste 189 

poisonous  fish    ....    187 

meat 187 

mushrooms    ....    185 

pomades,  as 188 

poppies,  syrup  of  .    .    .    188 
potassium  cyanide   .    .    178 

proof  spirit 180 

prussic  acid 178 

ptomaines 187 

quick  lime     ....        180 
rat  paste 181,  189 

poison 189 

rectified  spirits     .    .    .     180 
red  oxide  of  mercury  .    187 

precipitate     ....    187 

Ringeisen's    rat    paste 

and    vermin 

killer    .    .  181-189 

Roth's    rat    paste    and 

vermin     killer 

181-189 

rum 180 

rye,  ergot  of 185 

St.  Ignatius  bean     .    .    188 
salts  of  lemon    ....    178 

sorrel 178 

Scheele's  emerald  green  181 


Poisons  (continued) 

Scheele's  prussic  acid    .  178 
sedative  solution,   Bat- 

tley's.     ...    188 
sedatives    for    (see  de- 
m  ulcents 
above)         .    .    177 

sewer  gas 185 

silver  nitrate     ....    183 

snake  bites 116 

soda,  caustic 180 

soothing  syrup,    moth- 
er's   188 

Spanish  fly 182 

spirit,  methylated    .    .    180 

proof 180 

rectified 180 

spirits  of  camphor    .    .    183 
hartshorn  ....    180 

salt 177 

turpentine     ...    190 
stimulants  for 

beef  tea,  coffee  (or 
tea),  cold  and 
hot  douches  al- 
ternately, sal 
volatile  (aro- 
matic spirit  of 
a  m  m  o  n  i  a), 


spirits  (brandy 
or  whiskey) 

stings  of  insects 

strong  acids  . 

strychnia    .    . 

sugar  of  lead 

sulphate  of  copper 

sulphuric  acid 

sweetmeats    .    . 

syrup  of  chloral 

poppies  .    . 

soothing     .    . 


176 
116 

177 

188 
186 
184 
177 
188 
183 
188 
188 


INDEX 


233 


Poisons  (continued) 

tartar  emetic     ....    181 
tartarated  antimony    .    181 

tin 190 

impurities  of  .  .  .  181 
tincture  of  opium  .  .  188 
tinned  fruits      ....    181 

tobacco 190 

turpentine 190 

oil  of 190 

spirits  of 190 

turps 190 

verdigris 184 

vermin  killer    181,  188,  189 
Vienna  green     ....    181 

vitriol,  blue 184 

oil  of 177 

white 190 

wall  papers 181 

whiskey 180 

white  arsenic     ....    181 

lead 186 

precipitate     ....    187 

vitriol 190 

wine  of  antimony     .    .    181 

opium 188 

zinc 190 

chloride 190 

sulphate 190 

Pomades,  poisonous  .  .  188 
Popliteal  artery  ....  87 
Posterior  tibial  artery  .  .  88 
Potash  caustic  jwisoning  180 
Poultices  and  fomenta- 
tions ....  221 
Precipitate,  red,  poisoning  187 
white,  poisoning  .  .  187 
Prussic  acid  poisoning  .  178 
Ptomaine  poisoning     .    .    187 

Quick  lime  poisoning     .    180 


Radial  artery     ....      87 
Radius,  fracture  of  .    .    .    144 
Rat  paste  poisoning     .    .    189 
Respiration,  artificial    98,  157 
Ribs,  fracture  of  ....    132 
Roller,  bandages,  kinds  of    66 
Roth  and  Ringeisen's  ver- 
min killer  poi- 
soning    .    .    .    181 
Rubini's  solution  poison- 
ing .    .    .    •    •    183 

Salt,  for  wounds  •    112 

Salts  of  lemon  poisoning  178 
of  sorrel  poisoning  .  178 
Scalds,    immediate  treat- 
ment of  .    .    .    207 
Scalp,  bandage  for  wounds 

of 20 

Scheele's  acid    poisoning  178 

emerald  green  poisoning  181 
Scultetus,  bandage  of  .  .  72 
Sedatives  in  poisoning  .  177 
Selection  of  sick  room  .  215 
Shock      195 

from  burns 208 

Shoulder,  bandage  for  .  50 
for  wounds  of  .  .  .  24 
Sick  room,  selection  of  .  215 
Simpson's  rat  paste  poi- 
soning .  .  .  189 
Skull,  fracture  of  ....    128 

base  of 128 

Sling,  broad  arm .    .    .  17,  137 

large 17 

narrow 16 

Snake  bites 115 

Soda  caustic  poisoning  .  180 
Soothing  syrup  poisoning  188 
Spanish  fly  poisoning  .  .  182 
Special  bandages  ....      69 


234 


INDEX 


Spica  ])anda;ifs    ...  52-56 
S)Mne,  fracture  of      .    .    .  131 
Spirits  of   hartshorn   poi- 
soning    .    .    .  180 
salt  poisoning    .    .    .  177 
methylated,     poisoning  180 
])roof,  poisoning    ...  180 
rectified  poisoning    .    .  IhO 
Splint  fixing  to  limb  im-  38 

provised      125 

looped  triangular  band- 
age for    ...  39 

to  apply 125 

Sprain  of  thumb,  bandage  53 

Sprains 117 

Sqnare  bandage    ....  69 
S(iuire's  bandage  for  palm  32 
St.  Ignatius  bean  poison- 
ing ....  188 
Stimulants  in    poisoning 

cases    ....  176 

Stings  of  insects    ....  115 
S  trangu  lation ,      asphy  x  la 

from        ...  170 

Strychnine  poisoning  .    .  188 
Stump  of   limb,   bandage 

for 37 

Styptics       78 

Subclavian  artery     ...  84 

Sulphuric  acid  poisoning  177 

Sunstroke       200 

Sweetmeats,  })oisonous    .  188 
Sylvester's  method  of  ar- 
tificial respira- 
tion    .    .    .98,  157 
Syncope     .    .                .97,  192 
S3'rn})  of  poppies,  poison- 
ous      ....  188 

Tarsus,  fracture  of     .    .  156 

Temporal  artery    ....  82 


Thigh,  bandage  for  ...  33 
Tibia,  comjjound  fracture 

of 120 

fracture  of      155 

Tin,  salts  of,  poisoning  .  190 
Tinned  fruits  poisoning  .  181 
Tobacco  poisoning  .  .  190 
Tourniquet,    to   i  m  p  r  o  - 

vise  a    .  40,  94 

Transport  of  injured  per- 
son .        .126,  219 
Turpentine  poisoning  .    .    190 
Twisted  bandage  ....      63 

Ulnar  artery  ...  87 

Unconsciousness  action  in 

case  of  ...  201 
Upper    extremities,    to 

bandage  .    .  56 

Uraiuiic  convulsions     .    .    206 

Varicose   vein,   how  to 

treat  a  burst  .  79 
Verdigris  poisoning  ,  .  .  184 
Vermin    killer   poisoning 

188,  189 

Vitriol,  blue,  poisoning  .     184 

"white  poisoning     .    .    .     190 

Volker's  stick  tonrni(|uet     JJ6 

Vomiting  of  blood     .  103,  105 

Wound  of  abdomen    .    .  26 

arm      2(i 

chest    .        25 

chin 2-2 

ears 22 

elbow 27 

eyes     .....  22 

face 22 

foot      33 


INDEX 


23^ 


foreliead 22 

groin        37 

hand        28 

hip .  33 

knee 33 

leg        33 

neck 24 

palm 30 

perinreum 35 

scalp 20 

shoulder 24 

stump  of  limb   ....  37 

temple 22 

thigh 33 

wi-ist       28 

Wounds   bandages  for  20 

bullet 109 


clean  cut 108 

contused 114 

definition  of 1(18 

immediate  treatment  of  109 

incised 118 

lacerated  .        .        .  109,  114 

poisoned 108,  114 

punctured 114 

simple 108 

staJ)         109 

to  cleanse Ill 

dress        112 

Wrist,  bandage  for  .    .    .  28 

fracture  of      146 

Zinc,  chloride  of,  poison- 
ing   190 


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ETIQUETTE  There  18  no  oasspon    »o  good   soci't% 

Sv  Agnes  H  Morton  &^e  good  manners.  ^  Evei.  ll:ough  cne 
possess  wealth  and  inteUigence,  1  is  suc- 
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^  A  perusal  of  this  book  will  prevent  such  blunders.  It  ts 
=^  book  for  ever^^body,  for  the  social  'eaders  as  well  as  foi 
those  less  arr'.  -tious.  ^  The  subjed  is  presented  in  a  bnght 
and  <ntere5>*iig  manner,  and  represents  the  late^  vogue 

LETTER  WRITING      Why  do  mo^  persons  dislike  lo 
By  Agnes  H.  Morton  vmte  letters  7     Is  it   not  because 

they  cannot  say  the  right  thing  m 
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acceptances,  letters  of  sympathy,  congratulations,  and  'ov* 
'etters 

QUOTATIONS  A  clever  compilation  of  pithy  quota 
By  Agnes  H.  Morton  bons,  seleded  from  a  great  variety  ot 
sources,  and  alphabetically  ananged 
according  to  the  sentiment.  ^  In  addition  to  all  the  populai 
quotations  in  current  use,  it  contains  many  rare  bits  of  prose 
and  verse  not  generally  found  in  similar  colledions.  ^  One 
important  feature  of  the  book  is  found  in  the  chara<5leri^ic 
lines  from  well  known  authors,  in  which  the  iamiliaj  saym^ 
we  credited  to  theii  original  sources. 


rPllAPf^^  Even    death   has   «ts    humorous    sidf 

?v  Frederic  Vi-  Unger      ?  There  are  said  to  be  "  sermons  in 

Tories,"  but  when  they  are  tomb^one? 

ht-re  IS  many  a   smile   mixed  with  the   moral.  ^  Usuaii> 

hurchyard  humor  is  all  the  more  delightful  because  it  is 

inconscious,  but  there  are  times  when  it  is  inlentiona!  ana 

none  the  less  amusing.  ^  Of  epitaphs,  old  and  new,  «his 

book  contains  the  be^.     It  is  full  of  quaint  bits  of  obituaiy 

fancy,  with  a  touch  of  the  gruesome  heie  and  there  Joi  a 

retsh. 

PROVERBS  The  genius,  wit,  and  spirit  of  a  nabon 

By  John  H  BechteJ  are  discovered  in  its  proverbs,  and  the 
condensed  wisdom  of  all  ages  and  all 
nations  is  embodied  in  them.  ^  A  good  proverb  that  fits 
the  case  is  often  a  convincing  argument.  ^  This  volume 
contains  a  representative  colledion  of  proverbs,  old  and  new. 
and  the  indexes,  topical  and  alphabetical,  enable  one  to  fin</ 
readily  ju^  what  he  requires. 

THINGS   WORTH      Can  you  name  the  colde^  place  a 
KNOWING  tHe  United  States  or  teO  what  yea) 

By  John  H  Bcchtcl  ^^^  445  days  ?      Do  you   knov»- 

how  soon  the  coal  fields  of  the 
world  are  likely  to  be  exhau^ed,  or  how  the  speed  ol  a 
moving  train  may  be  told  ?  What  should  you  do  fir^  ii 
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lowed  a  pm  >  This  unique,  up-to-date  book  answers  thou 
Wids  ol  luSt  «uch  mtere^g  and  useful  que^on& 


4  Dictionary  of    Mo^  oi  us  disfike  to  look  up . 

MYTHOLOGY  mythological     subjed     because 

dyJohnH  Bechtel  ^^   '^^  time    required.   |81  This 

book  remedies  that  difficulty 
because  in  it  can  be  found  at  a  glance  ju^  what  is  wanted 
^  It  is  comprehensive,  convenient,  condensed,  and  the  infor 
mation  is  presented  in  such  an  intere^g  manner  that  when 
once  read  it  will  always  be  remembered.  ^  A  di^indive 
feature  of  the  book  is  the  pronunciation  of  the  proper  names, 
something  found  in  few  other  works 

SLIPS   OF   SPEECH      Who    does   not    mak-    them? 
By  John  H  Bechtci  The  be^  of  us  do.  ^  Why  not 

avoid  them  ?  Any  one  inspired 
with  the  spint  of  self- improvement  may  readily  do  so.  ^  No 
necessity  for  studying  rules  of  grammar  or  rhetoric  when  this 
book  may  be  had.  It  teaches  both  ivithout  the  ^udy  ol 
either.  ^  it  is  a  counseDor,  a  cntic,  a  companion,  and  a 
guide,  and  is  written  in  a  mo^  entertaining  and  chatty 
ayle. 

HANDBOOK   OF  What   is  more  disagreeable 

PI^ONUNCIATION      l^an    a    faulty    pronunciation? 

8v  John  H  Bechtel  ^o    othei     defed     so    cl^rly 

shows  a  lack  or  culture.  ^  Tins 
book  contains  over  5.000  words  on  which  mo^  of  us  are 
apt  to  trip.  ^  They  are  here  pronounced  in  the  cleared  and 
«mple^  manner,  and  according  to  the  be^  'iiithority.  ^  It  is 
more  readily  consuited  tlian  a  dictioiiary.  and   it   lud   <m 


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